Dear Dr. Pat,
I am a 52 year old woman with regular menstrual cycles. I had two pregnancies and two children. I have never used birth control pills and I still have regular menstrual cycles that have not changed in anyway. My periods are not long or heavy. I do not have any menstrual pain. There is no cancer at all in my family I have never smoked and drink very little alcohol. I am in a long term marriage and should not be at any risk of a sexually transmitted disease..
I have had 4 months of new urgency to urinate and a feeling that my bladder does not empty completely. There are no other symptoms of a bladder infection and in fact I had a normal urine analysis and 2 normal urine cultures.
I asked my gynecologist to do a Ca125 blood test for ovarian cancer and a pelvic sonogram because my best friend died of ovarian cancer after her symptoms were not thoroughly evaluated for months.
The blood test for Ca125 was 2 points over the normal range (so slightly elevated) and the pelvic sonogram was normal except that a 2 cm simple (small) cyst was found in the left adnexal region (I am told that it is next to the ovary or fallopian tube but not part of the ovary or fallopian tube). I know that you can not give me medical advice but could you give me some information about the symptoms of ovarian cancer and the tests that are done to find this terrible cancer earlier?
Margaret
Dear Margaret,
These are the situations that patients and gynecologists deal with daily. What tests to do and then how to deal with the often ambiguous findings. I have asked Dr. Elizabeth Poynor, a board member of Women’s Voices for Change and a member of our medical advisory board, to give you and our readers more information about early detection of ovarian cancer.
Dr. Pat
Up until recently, ovarian cancer was considered to be completely asymptomatic until it had spread throughout the abdomen. It was labeled as a “silent disease”. About 5 years ago a study was published which demonstrated that women with ovarian cancer may have some symptoms for up to one year prior to diagnosis of the disease. These symptoms are subtle, and now we no longer strictly label ovarian cancer a silent disease, but one that whispers. Because of this subtle nature, many of the symptoms of ovarian cancer unfortunately may go ignored by both women and their physicians.
The early warning signs and symptoms of ovarian cancer may include: urinary frequency, pelvic pain, abnormal vaginal bleeding, abdominal bloating, indigestion, back pain and fatigue. The difficult part of evaluation of these symptoms is that these symptoms are quite common. In fact many women have these symptoms at some point in their lives and these symptoms are completely unrelated to ovarian cancer. The take home message is: any symptom that is new for you and persistent should be completely evaluated. This evaluation may include ruling out ovarian cancer with a pelvic ultrasound and a blood test, CA125.
The diagnosis of early ovarian cancer can be difficult, and many of the tests used to evaluate for the presence of ovarian cancer may be non-specific and yield false positive results. The pelvic ultrasound may demonstrate ovarian cysts, which are a common finding in women throughout their lives. The question then becomes which cysts are significant and require further evaluation, either through follow-up studies or surgical intervention. Ovarian abnormalities that may require further evaluation include: large clear cysts, clear cysts that are enlarging or causing symptoms, and cysts which are not clear but contain other tissue components. A physician may recommend a follow-up ultrasound or a surgical intervention, depending on how suspicious the cyst is for a potential malignancy.
Part of the evaluation for ovarian cancer may also include the CA125 blood test. CA125 is a protein that ovarian cancer cells may produce. Some benign processes such as fibroids and endometriosis may also produce elevated levels of CA125, and normal cells also produce CA125 so that there are often slight elevations in the CA125 levels of a woman when ovarian cancer is not present. The CA125 should then be repeated if it is elevated, and further evaluation is required when the levels remain persistently elevated.
There are newer tests currently in development and in early clinical use that may be helpful in determining the presence of ovarian cancer. These include OvasureTM which is a test developed at Yale and marketed through Labcorp. The utility of this test is yet to be well proven, however it may be used in highly selected situations with careful counseling concerning the experimental nature of the test. Doctors and scientists are waiting for additional data in order to further clarify the utility and proper use of this test.
The take home messages are: if you have symptoms that are new and persistent, see your doctor for evaluation. If you do not get answers, seek additional opinions or ask for a referral to a specialist. If a cyst or an elevated CA125 is found on your evaluation, do not panic as these can be common findings and tests may be repeated in order to evaluate for trends. When a surgery is recommended, you may want to seek a second opinion with a specialist in order to maximize your chances of having a minimally invasive or laparoscopic approach, offered to you. Gynecologic cancer specialists know all too well that in the surgical diagnosis and treatment of ovarian cancer, the first surgery is always the most important one.
Elizabeth Poynor, MD
Ovarian cancer is not common, but it can be lethal. If you think that you may be at elevated risk to develop ovarian cancer, bring these factors to the attention of your personal physician.
Ovarian cysts are common in post-menopausal women, and most are not cancerous. But any ovarian cyst should be taken seriously.