The Risk of Ovarian Cancer

Ovarian cancer has been called the silent killer because it often produces no symptoms until it has spread beyond the ovary. It is the 5th most common cancer and 5th most common cause of cancer deaths in women. It is less common than endometrial cancer, but causes twice as many deaths.

Some but not all cases run in families. A woman with a strong family history of ovarian or breast cancer should consider genetic testing for BRCA-1 and BRCA-2 cancer genes, which cause breast and ovarian cancer. Women with these genes can have their ovaries removed after childbearing to reduce the risk of ovarian cancer.

Like most cancers the risk for ovarian cancer increases with age. Typical symptoms include bloating, abdominal swelling, vaginal bleeding, and changes in bladder and bowel habits. If symptoms persist, a thorough gynecological evaluation is performed, beginning with a speculum exam. If an ovarian mass is found or there is fluid in the pelvis, ultrasound can confirm these findings. Fluid in the pelvis may be removed and analyzed for cancer cells. If cancer cells are found or a suspicious mass is seen, surgery may be necessary.

Ovarian cancer confined to the ovary can be cured by surgically removing the ovary. Women whose cancer has spread outside of the ovary (advanced stage) are often advised to have a different surgery, called debulking, which aims to remove the bulk of cancer from the pelvis and abdomen. After surgery, residual cancer cells are attacked with chemotherapy. Radioactive treatments are sometimes given if a stubborn spot remains or becomes problematic. Women can acheive a partial or complete remission that lasts for years. Patients are monitored with CAT scans and CA-125, which is a blood test for a molecule shed by cancer cells and used to determine if cancer is returning to an active state.

Women who relapse can be treated with chemotherapy drugs, given singly or in combination. Approximately 10 drugs are active against ovarian cancer. Although chemotherapy is effective, the cancer cells can become resistant over time.

There are no effective screening tests for women who don’t have symptoms? such a test could theoretically detect ovarian cancer in the early, more treatable stages. The CA-125 blood test and trans-vaginal ultrasound are not accurate enough for this purpose. Research continues to develop such a screening test, like mammogram for breast cancer, to safely screen large populations.

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