Ovarian cancer is said to have no apparent early symptoms, and while the symptoms are generally nonspecific, if you are aware of what they are, you can identify any concerns early to your doctor. As of 2009, there are no reliable, accurate, and clear screening tools for ovarian cancer, which contributes to the fact that more than half of these cancers are diagnosed at a late stage, when the symptoms become too obvious to ignore.
Background
Nearly 20,000 new diagnoses of ovarian cancer are made each year in the United States, and it is the leading cause of death from gynecologic cancer. Overall, in women, it is the fifth most common cause of cancer death. Risk factors for the disease include a family history, never having children, older age, white race, and late menopause. Pregnancy and the use of oral contraception have been associated with a slightly lower risk of ovarian cancer, which suggests that continuous ovulation without breaks contributes to the development of ovarian cancer.
Clinical Symptoms
Early signs and symptoms of ovarian cancer include abdominal bloating and distention, absence of hunger, weight loss, constipation and gastrointestinal problems, unexplained vaginal bleeding, pain with intercourse, fatigue and feelings of being full after eating only a small amount. Many times when women present with these complaints, they are examined for irritable bowel syndrome, gall bladder problems and gastrointestinal diseases. If these symptoms persist for more than two weeks, concerns about possible ovarian cancer should be discussed with a doctor. Early-stage disease can have no symptoms, with the symptoms only appearing as the cancer progresses, which is why early detection is key.
Screening and Testing
For women with a strong genetic history of ovarian cancer and who are therefore at higher risk, the National Cancer Institute does recommend screening annually with transvaginal ultrasounds and CA-125 blood tests. In the general population, the benefits of these general tests have not been proven, and there is no standard screening tool for ovarian cancer. No definitive test has been developed, and the only way of definitively diagnosing ovarian cancer is by surgical exploration.
Genetic Factors
Women with a BRCA mutation have higher risks of developing breast and ovarian cancer than women who do not have these mutations. Ethnic groups like Ashkenazi Jews have been shown to have a higher risk of having these mutations. Those with a BRCA1 mutation have a 16 percent to 44 percent lifetime risk of developing ovarian cancer, and women with BRCA2 mutations have a lifetime risk of 10 percent. In women with a BRCA1 or BRCA2 mutation, having a prophylactic oophorectomy has been proven to reduce the risk of developing both ovarian and breast cancer.
Treatment
To stage the disease, surgery is performed, which is typically done through a total abdominal hysterectomy and bilateral salpingoophorectomy. In this surgery, both ovaries and fallopian tubes are taken out. It involves biopsies from the pelvic and abdominal peritoneum (lining), a biopsy of the omentum or an omentectomy, and lymph node dissection. It is important that as much of the cancer as possible is removed for the best prognosis, and this is called optimal debulking.
After surgery, a course of chemotherapy is usually decided on, and possible second-look surgeries are done.
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