Ovarian Cancer Diagnosed by Symptoms plus Blood Test
Researchers boosted the level of early-stage ovarian cancer detection by 20 percent through use of a blood test to detect a tumor marker as well as a woman's report of new-onset symptoms.
Using either test alone only uncovered about 60 percent of early-stage ovarian cancers in a high-risk group of women.
Using the two techniques together found 80 percent of early-stage tumors, according a report in the journal Cancer.
"They appear to act complementary, and appear to be able to identify women who would not be identified by a blood sample alone, and conversely would not be identified by symptoms alone," says the study's lead author, M. Robyn Andersen, Ph.D., at the Fred Hutchinson Cancer Research Center in Seattle.
More than 21,000 women are diagnosed with ovarian cancer annually, and more than 15,000 women die from the disease each year, according to the American Cancer Society (ACS).
Currently, only about 20 percent of ovarian cancers are caught in their earliest, potentially curable stages, according to Dr. Andersen.
In 2006, Dr. Andersen's colleague, Dr. Barbara Goff, at the University of Washington, published the ovarian cancer symptom-screening index tool, in an effort to help women and physicians clarify which women might have a heightened risk of ovarian cancer.
Important symptoms include pelvic or abdominal pain, bloating, increased abdominal size, difficulty eating, or feeling full quickly.
These symptoms must occur more than 12 times per month, and have just recently begun occurring (within the past year), to be considered positive on the symptom-screening tool.
For example, if a woman has had abdominal pain for the past 10 years, it is probably not related to ovarian cancer, but to another disorder, such as irritable bowel syndrome.
For the current study, Dr. Andersen and her colleagues used the symptom-screening index and a blood test that looks for CA 125, a protein that is often elevated in ovarian cancer. However, CA 125 can sometimes be elevated in women who do not have ovarian cancer, the researchers noted.
The study involved 254 healthy women at high-risk for ovarian cancer because of family history, as well as 75 women about to undergo surgery to remove an ovarian cancer. The women were asked to fill out a questionnaire about their symptoms. All of the women also gave a blood sample to have their levels of CA 125 measured.
The two methods together correctly identified almost 90 percent of the ovarian cancers - 80.6 percent of the early cancers and 95.1 percent of the later-stage cancers.
About 14 percent of women who had symptoms and had elevated levels of CA 125 did not have ovarian cancer, according to Dr. Andersen. These women received transvaginal ultrasound tests for follow-up, Dr. Andersen says.
Debbie Saslow, Ph.D., director of breast and gynecologic cancer for the American Cancer Society (ACS), says, "This study continues to add on to the work that's been done, but we still have a long way to go with ovarian cancer.
"None of the current screening tools is as accurate as the ACS and other experts would like them to be," she explains.
Any of the tests alone misses a significant number of cancers, and unnecessarily worries women who do not have cancer.
Dr. Saslow says transvaginal ultrasound can be a good test, but it has to be done by an experienced sonographer, and there are no current guidelines to define how much experience is enough.
Additionally, Dr. Saslow notes that no research has been done to prove that early detection saves lives.
Dr. Andersen says the researchers recommend that if you have any of the symptoms of ovarian cancer, and they are new-onset symptoms, that you should discuss them with your physician.
But, she adds, "Even with this specific pattern of symptoms, most women probably don't have ovarian cancer, just as most women with a breast lump don't have breast cancer."
Always consult your physician for more information.
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The cause of ovarian cancer is not yet known. An estimated 21,650 new cases of ovarian cancer are expected in the US in 2008. Ovarian cancer is the eighth most common form of cancer among women.
The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer.
The following have been suggested as risk factors for ovarian cancer:
- early menarche - starting monthly periods early - before the age of 12
- late menopause (after the age of 52)
- age - over the age of 50
- hormone replacement therapy. Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.
- infertility (inability to become pregnant)
- having a first child after the age of 30
- personal history of breast or colon cancer
- family history
First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
- certain fertility drugs
Common symptoms of ovarian cancer include general discomfort in the lower abdomen, including feeling swollen or bloated; a loss of appetite or a feeling of fullness even after a light meal; gas, indigestion, and nausea; weight loss; diarrhea or constipation; or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder.
Other symptoms may be bleeding from the vagina, or build up of fluid around the lungs, which may cause shortness of breath.
The American Cancer Society (ACS) recommends that if any of these symptoms occur almost daily or last a few weeks and are new, the woman should seek the attention of her physician.
In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage.
Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic examination.
The physician may also order other tests, including ultrasound, computed tomography (CT or CAT scan), lower gastrointestinal (GI) series, intravenous pyelogram (IVP), a blood test to measure a substance in the blood called CA-125; or biopsy, a procedure in which tissue samples are removed from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
The diagnosis of cancer is confirmed only by a biopsy.
Always consult your physician for more information.
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