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| health > cancer > story page |         |
Ovarian cancer: It's less common than you thinkSeptember 3, 1999
By Laurie Green, M.D.
(WebMD) -- When comedian Gilda Radner died of ovarian cancer in 1989, the world learned more about ovarian cancer than it had ever known. And with the recent death of Liz Tilberis, former editor in chief of Harper's Bazaar, this past April, ovarian cancer has once again become a topic of conversation among women and their physicians. In addition, one woman's battle against peritoneal cancer, a malignancy of the lining of the abdomen that has many of the same features as ovarian cancer, has recently spread over the Internet. But women should realize that, although ovarian cancer is receiving more press, it still ranks low on a woman's list of health concerns: Ovarian cancer accounts for only 4 percent of all cancers in women, according to the American Cancer Society. Putting the numbers in perspective The reality is that a woman's chance of developing ovarian cancer is small, somewhere around 1.5 percent. And when it is found and treated before spreading outside the ovaries, the five-year survival rate is 95 percent -- more curable than early-stage breast cancer. However, only 25 percent of ovarian cancers are found in their early stages. There are several reasons for this: 1. Ovarian cancer is often silent in its early stages. Symptoms that arise are nonspecific and include pelvic pain, bloating, abdominal swelling, indigestion and pain during intercourse. 2. Screening for ovarian cancer is not very reliable. A blood test called a CA 125 level, originally promulgated after Radner's death, initially gave researchers reason to hope. The CA 125 level rises above normal in women with some types of ovarian cancer. However, CA 125 levels fail to rise in 75 percent of the subtypes of ovarian cancer. More importantly, the test has a high false-positive rate. It is abnormal in 8 percent of women with no pelvic disease whatsoever; conditions such as endometriosis and fibroid tumors can also cause the level to rise. Studies show that of every 100 women with elevated CA 125 results, only 3 actually have ovarian cancer. Since a definitive diagnosis of ovarian cancer often requires surgery, a large proportion of the 97 women with false-positive CA 125 levels end up on the operating-room table undergoing an invasive surgical procedure (either laparoscopy or laparotomy). Thus, "screening" with CA 125 levels delivers neither the accuracy nor the reassurance that other screening tools, such as mammography, afford. Clearly, more sensitive methods of screening are needed. In the meantime, women at high risk should discuss a variety of approaches with their doctors. Tools such as ultrasound and frequent pelvic examinations are recommended, in addition to the CA 125 level test, for women at a higher than normal risk of ovarian cancer. Besides age (most ovarian cancers develop after menopause), factors linked to an increased risk are: 1. A family history of ovarian cancer. About 7 percent of ovarian cancers result from an inherited tendency to develop the disease, according to the American Cancer Society. 2. A personal history of infertility. 3. Never having given birth; having a first child after age 30; or having started menstruating before age 12. 4. A personal history of breast cancer (including the inherited breast cancer genes, BRCA1 and BRCA2), uterine lining or colon cancer. Fertility drugs and talcum powder have both been implicated as causal agents in ovarian cancer. While researchers are still gathering long-term data, to date there is no clear-cut evidence of a causal relationship between fertility drugs and cancer. The ruling on talcum powder is still unclear, as well. In the past, talcum powder was sometimes contaminated with asbestos, a known cancer-causing mineral. However, talcum powder has been asbestos-free for 20 years, as required by law. Further studies are needed to completely rule out talcum powder's role in ovarian cancer. How does ovarian cancer develop? Most ovarian cancers begin as cysts, or fluid-filled sacs, within the ovary itself. Malignant cells commonly "shed" into the abdomen, causing the cancer to spread to the peritoneum and nearby internal organs. A small curtain of fat called omentum, which drapes off the colon, is a common site for ovarian cancer to "shed." Ovarian cancer also metastasizes (spreads) through the lymph system and by direct invasion of organs adjacent to the ovaries. While most ovarian cancers start out as cysts, the overwhelming number of ovarian cysts are NOT cancers. In fact, normal ovarian function demands that cysts are present throughout a normal menstrual cycle. But benign cysts are rarely identified in the ovaries of postmenopausal women. Any ovarian cyst found in a postmenopausal woman should be investigated to rule out cancer. During a pelvic examination, the doctor will palpate the cyst; malignant cysts tend to be firmer than benign cysts and irregular in shape. Ultrasound can also help distinguish benign from malignant cysts. A special type of ultrasound called a color-flow ultrasound differentiates the blood flow between benign and malignant tumors. As one might expect, the blood flow to a malignant, rapidly growing tumor is far more brisk. The standard treatment of ovarian cancer is a combination of surgery and chemotherapy. During surgery, the pelvic organs (uterus, tubes, ovaries), the omentum and the lymph nodes are typically removed and analyzed. Depending upon the microscopic findings, further treatment is recommended. Recently introduced chemotherapeutic agents such as cisplatin and paclitaxel have yielded promising results in treating the most common ovarian malignancies. If you are concerned about ovarian cancer, be sure to discuss the worries with your doctor. Learn as much as possible about your family cancer history, including cousins, nieces and aunts. A reasoned strategy can reduce anxiety and potentially prevent cancer.
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Epithelial ovarian cancer RELATED SITES: American Cancer Society: The Ovary Cancer Resource Center LATEST HEALTH STORIES: China SARS numbers pass 5,000
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