Ovarian Cancer is the fifth leading cause of death among women in the United States and is the most deadly of the gynecologic cancers.
It is estimated that in 2016, approximately 22,280 women will be diagnosed with ovarian cancer and about 14,240 will die from the disease.
Ovarian Cancer is not an uncommon disease, occurring in 1 of every 75 women
When ovarian cancer is detected early, before it has spread beyond the ovaries, more than 90% of women will survive longer than five years. Only 15% of women are diagnosed in the early stages.
Currently, 50% of women diagnosed with ovarian cancer die from the disease within five years. When diagnosed in advanced stages, the chance of five- year survival is only 45%.
Ovarian cancer is often difficult to diagnose because symptoms may be subtle, are easily confused with other diseases and because there is no single reliable easy-to-administer screening tool.
Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Urinary symptoms (urgency or frequency)
Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.
Women who have these symptoms almost daily for more than a few weeks should see their doctor,
preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible
stage of the disease. Early stage diagnosis is associated with an improved prognosis.
Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also
found in equal frequency in women in the general population who do not have ovarian cancer.
Consult a healthcare professional if any symptoms persist for more than two weeks and are unusual for you. A Pap test does not detect ovarian cancer.
Historically, physicians have utilized the CA-125 as a blood test to evaluate the likelihood of ovarian cancer in patients. The CA-125 test is not completely accurate as many noncancerous conditions can also result in increased levels of the protein. As a result, up to 50% of early stage cancers are not detected by CA-125. There are new tests that have been developed to be better than CA-125 alone at detecting all types of ovarian cancer.
The Society of Gynecologic Oncology (SGO) put out a statement in May 2013 that states “Blood levels of five proteins in women with a known ovarian mass have been reported to change when ovarian cancer is present. Tests measuring these proteins may be useful in identifying women who should be referred to a gynecologic oncologist. Recent data have suggested that such tests, along with physician clinical assessment, may improve detection rates of malignancies among women with pelvic masses planning surgery.”
OVA1® is an FDA-cleared blood test used to help evaluate the risk of ovarian cancer in patients with an adnexal mass (or pelvic mass) and planned for surgery. Using a powerful mathematical formula, the test generates an OVA1® score by combining the levels of five ovarian cancer biomarkers (including CA-125).
OVA1® has been FDA cleared for women who meet the following criteria: Are over 18 years of age, have an ovarian mass, have surgery planned, have not yet been referred to a gynecologic oncologist, have not had cancer in the past five years; and have a rheumatoid factor concentration <250 IU/mL. OVA1® should not be used without an independent clinical/radiological evaluation and is not intended to be a screening test or to determine whether a patient should proceed to surgery.
OVA1® is designed to be highly sensitive, meaning that it rarely misses a cancer. OVA1® has a sensitivity of ~96% across all ovarian cancer subtypes to ensure cancers are not missed. You can read more about OVA1® and how to qualify for the test here.
The Risk of Ovarian Malignancy Algorithm (ROMA™) is a qualitative serum test that combines the results of HE4, CA125-II and menopausal status into a numerical score to aid in assessing whether a premenopausal or postmenopausal woman who presents with an ovarian adnexal mass is at high or low likelihood of finding cancer on surgery.
ROMA is indicated for women who meet the following criteria: over age 18; ovarian adnexal mass present for which surgery is planned, and not yet referred to an oncologist. ROMA must be interpreted in conjunction with an independent clinical and radiological assessment. The test is not intended as a screening or stand-alone diagnostic assay.
ROMA performed well for advanced ovarian cancer and high-grade serous histology by capturing 93% and 94% of these subtypes, respectively. However, a high false negative rate was observed for early stage cancers, pre-menopausal patients and other histological subtypes. You can read more about the ROMA test here.
By utilizing the tools that are currently available, such as CA 125, OVA1, ROMA, ultrasounds, and multi-biomarker analytics, physicians can more easily sort pelvic masses and get patients the care they need to improve overall outcomes and survivorship.
If ovarian cancer is suspected, it is crucial to see a gynecologic oncologist who specializes in women’s cancers.
The staging of ovarian cancer is divided into four stages. Decisions about treatment vary based on the stage.
The goal of surgery is to optimally remove as much of the malignant process as possible. Unless the disease is confined to the ovary, surgery usually involves removing both ovaries, the uterus, fallopian tubes and the omentum.
Surgery is typically followed by chemotherapy. During and after chemotherapy, doctors monitor a woman’s progress with pelvic exams and with the CA-125 blood test. While the CA-125 blood test is not a reliable screening tool, it does reliably indicate whether the disease is recurring in women who have already been treated.
- Ovarian cancer is confined to one or both ovaries.
- Cancer is in one or both ovaries and has spread to other parts of the pelvis.
- Cancer is in one or both ovaries and has spread to nearby lymph nodes or to other abdominal organs, excluding the liver.
- Cancer is in one or both ovaries and has spread to the liver or sites outside the abdomen.
Like any cancer, why one woman gets ovarian cancer and another does not remains a mystery.
- Women of any age are at risk, however risk increases with age.
- If you have a personal or family history of ovarian, breast, colon or uterine cancer.
- If you have not borne a child.
The overwhelming majority of women who get ovarian cancer have no known risk factors.