Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Ovarian Cancer

Ovarian cancer is the fifth most common cancer among women. Approximately one out of seventy women will develop ovarian cancer. The majority of cases are diagnosed between the ages of 40-65. Ovarian cancer has sometimes been referred to as a silent killer because the symptoms of ovarian cancer are non-specific. These symptoms may include: irregular menstrual cycles, abdominal pain, unexplained bloating or nausea, unexplained weight loss, urinary frequency, and pain during sexual intercourse. Symptoms severe enough to prompt a woman to seek medical care are often the result of more advanced disease. Currently the largest barrier to early diagnosis of ovarian cancer is the lack of a good screening tool. All women are screened for ovarian cancer when a pelvic exam is performed during their annual well woman exam. During the pelvic exam, the clinician places two fingers in the vagina and his/her other hand is placed on the womans abdomen. The ovary is then palpated between the clinicians two hands. The use of the pelvic exam is limited both by ability of the clinician and the body habitus of the patient. For example, if the patient is obese, then an abnormal ovary is difficult to appreciate. Ultrasound is more sensitive for looking at the ovaries but it alone is not a sensitive tool for the diagnosis of ovarian cancer. In pre-menopausal women, the ovary is very dynamic. Each month, cysts are expected to appear and disappear in the normal ovary as the woman ovulates and then proceeds through the menstrual cycle. The presence of a large cyst alone does not necessarily indicate an abnormality. In post-menopausal women, the ultrasound becomes a more sensitive tool as the ovary should be inactive. Some cancers of the ovary produce chemical compounds that can be detected in the blood. These are often referred to as tumor markers. Tumor markers can be used to aid in the detection and monitoring of ovarian cancers, unfortunately they too are non-specific. CA-125 is the tumor marker that is most likely to be elevated in women with ovarian cancer. Unfortunately, it is not elevated in 50% of women who do have ovarian cancer. Also, there are many common non-cancerous causes of a falsely elevated CA-125. For example, both uterine fibroids and endometriosis can cause elevations of CA-125. Many studies are underway to develop better screening tools and several tumor markers are under investigation but are not yet clinically available. Currently, all women should receive a pelvic exam annually as part of the well woman exam. Women who may be at increased risk and require further evaluation include women who are obese, women with prolonged reproductive years, women with a family history of ovarian or breast cancer, and women with a personal history of breast cancer. Women who are obese are at risk both because of the difficultly in examining the ovaries and also because of the elevated hormone levels associated with being significantly overweight. Women who have a prolonged reproductive life may be at increased risk. In other words, women who started their menstrual cycles early in life (before age 12), continued their cycles late in life (after age 52), never had children, and never used birth control pills may be at increased risk because the ovaries have been more active over their lifetime. Other women who may be at risk include women with a first degree relative with breast or ovarian cancer. They should discuss with their physician the option of combined ultrasound and CA 125 testing. Women who have a personal history of breast cancer may also be at increased risk for ovarian cancer and should discuss the possibility of surgical removal of their ovaries with their physician.