According to the American Cancer Society, about 22, 000 women are diagnosed with ovarian cancer in the U.S. each year; about 14,000 of these patients will die as result of their cancer. It is most noteworthy that the five-year survival rate is 90% when ovarian cancer is diagnosed before it has spread beyond the ovaries. Yet, only about 20% of ovarian cancers are detected in the early stages.
Screening, more screening, monitoring and an understanding of the signs and symptoms of ovarian cancer are key to early detection. A myth that must be dispelled is that cervical cancer is the same as ovarian cancer. Just because a patient has a normal pap smear, does not exclude the possibility of ovarian cancer. Simply put, the pap smear test has nothing to do with the diagnosis of ovarian cancer. Unfortunately, recent studies suggest that many women rely on their normal pap smear result to conclude that they do not have an ovarian problem.
It must also be understood that what some doctors loosely characterize as an ovarian cyst does not necessarily exclude the possibility of ovarian cancer. If your doctor tells you that you have an ovarian cyst because of a mass identified on ultrasound, make sure to inquire about the basis for the conclusion that the mass is”just a cyst.” Sometimes the ultrasound is the only study performed to identify the mass. As great as ultrasounds are, they are not always the most accurate studies. This is particularly true for patients who are obese or overweight. Radiologists will often read ultrasounds in such patients as limited because of “body habitus” (the physique of the patient). Keep in mind that most of these ultrasounds are performed in clinics, and they are read by obstetricians, who are not trained radiologists. You must ask your physician if the mass is a solid mass or a mass filled with fluid. If it is a solid mass or your physician cannot answer the question, you may want to consider further studies. Don’t let your physician simply guess that the mass must be a cyst because of its size or because of some general statistical probability. In any event, both cysts and solid masses require further monitoring.
The symptoms of ovarian cancer include but are not limited to:
- Swollen abdomen
- Unusual or excessive vaginal bleeding
- Pelvic and/or abdominal pain and/or heaviness
- Back pain
- Unexpected weight gain or loss
- Increased urinary frequency or urgency
- Nausea and vomiting
If you and your physician suspect ovarian cancer, the following are useful diagnostic modalities:
- Alpha fetoprotein
- Blood chemistry
- CA125 (may be done if ovarian cancer is strongly suspected or has been diagnosed, and to follow the cancer during or after treatment)
- Quantitative serum HCG (blood pregnancy test)
- Abdominal CT scan or MRI of abdomen
- GI series
- Pelvic laparoscopy
- Exploratory laparotomy
If you are experiencing these symptoms, you may want to address the possibility of ovarian cancer with your physician. Some physicians will generally perform an ultrasound. If they are not impressed with the ultrasound, they may not pursue any other diagnostic modalities. If the ultrasound reveals a mass, some physicians may elect to wait and perform a follow-up ultrasound in a few months.
Notwithstanding how aggressive your physician is to rule out ovarian cancer, remember that physicians rely on your feedback, and you alone truly know the extent and severity of your symptoms. Depending on your clinical presentation, waiting for 3 or 6 months for a repeat ultrasound may be unacceptable. Ovarian cancer can spread quickly within a matter of a few months from a stage I cancer to a stage IV cancer. Take the initiative to fully explore all available diagnostic modalities with your physician. Don’t be uncomfortable asking your doctor for additional diagnostic tests or more frequent monitoring. The worst thing you can do is become a passive participant in a complex and stressful process guided by a physician, who may not fully appreciate the extent and severity of your symptoms.
If you are an ovarian cancer patient, share your story with our readers. How long did it take for you to find out you had ovarian cancer? In retrospect, what would you have done differently as a patient?