Ovarian Cancer: Common Questions About Symptoms and Screening

For many women, a visit to the gynecologist is simply a routine part of their yearly health regimen. But if you’re on autopilot at your annual exam, you may be missing the chance to talk with your doctor about a disease that affects thousands of women each year: ovarian cancer.

For years, ovarian cancer was known as the "silent" cancer because it rarely produced any symptoms and many women didn't find out they had it until the cancer was very advanced. Now, however, doctors have identified specific signs that may be associated with the disease, including bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and having to urinate often or always feeling like you need to go.

These symptoms are also commonly caused by non-cancerous diseases, but if they seem unusual for you or if you have these symptoms almost daily for more than a few weeks, it’s a good idea to talk to your gynecologist.

Debbie Saslow, PhD, director of breast and gynecologic cancers at the American Cancer Society, answers some common questions about ovarian cancer and explains why screening isn't a routine part of women's health care.

How do I know if I'm at risk for ovarian cancer?

There are several factors that increase a woman's risk of developing ovarian cancer. Age is an important one; most ovarian cancers develop after menopause. Ovarian cancer can also run in families. Women with a mother, sister, or daughter who has had ovarian cancer are at a higher risk of developing the disease themselves. So are women with a mutation in the BRCA1 or BRCA2 gene (which also raises breast cancer risk). Other factors that may increase risk include being obese, using fertility drugs for longer than 1 year, using estrogen replacement therapy after menopause, and having been diagnosed with breast cancer.

Factors that may lower a woman's risk of developing ovarian cancer include having used birth control pills, having her tubes tied (tubal ligation), and having a hysterectomy. Having children and breast feeding may also lower the risk of ovarian cancer.

I get screened regularly for breast cancer and cervical cancer. Why doesn't my doctor check me for ovarian cancer, too?

We don't have tests like mammograms or Pap tests for the ovaries. Doctors often perform a pelvic exam, which includes checking the ovaries, but this exam rarely detects ovarian tumors unless they have grown very large.

Some other tests, like the CA-125 blood test and transvaginal ultrasound, have been studied to see if they can be used to screen for ovarian cancer, but none are accurate enough.

The CA-125 test measures a protein that can be found in the blood of many women with ovarian cancer. However, other conditions can also raise CA-125 levels in the blood, and some women with ovarian cancer may still have normal CA-125 levels. Transvaginal ultrasound can find a mass on the ovaries, but cannot determine if that mass is cancer or something less dangerous, like a cyst.
Because of these problems, these tests are not recommended for women at average risk, but they may be used for women at high risk or who have symptoms that may suggest ovarian cancer. Even in these women, however, these tests are problematic and their use is limited.

Are there any newer tests that are more reliable?

There has been research and attempts to develop a blood test for ovarian cancer. These are based on measuring genes or proteins that may be present in higher or lower amounts in women with ovarian cancer compared to women who do not have ovarian cancer. Unfortunately none of these tests has yet been proven to be accurate, effective, or to save lives. No test has been validated (studied in large groups of women to see if it actually helps find ovarian cancer early) nor undergone FDA review. The American Cancer Society, other health organizations, and ovarian cancer advocacy groups encourage additional research to develop an accurate and valid test for early detection of ovarian cancer.

I've heard that many women with ovarian cancer actually do have symptoms. What are these symptoms and what should I do if I have them?

Certain symptoms suggestive of ovarian cancer have been reported in a national consensus statement (June 2007) issued by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society. The symptoms most commonly associated with ovarian cancer include:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)

These symptoms are more likely to persist in women with ovarian cancer than women in the general population. However, they are not unique to ovarian cancer, and in fact most women who have these symptoms will not have ovarian cancer. Women who have these symptoms almost every day for at least several weeks should see their health provider.

My doctor has ruled out all the common causes for my symptoms. What tests can be done to look for ovarian cancer?

Guidance to physicians for women in this situation is available from the Ovarian Cancer National Alliance . The tests include a thorough physical exam, CA-125 blood test, and transvaginal ultrasound. However, only an invasive procedure like laparoscopy or open surgery can confirm that a woman has ovarian cancer, and these procedures carry their own serious risks.

Is research being done in this area? What are the most promising findings?

There are many studies being done to find better ways of detecting ovarian cancer. Some are studying symptoms of ovarian cancer. Some are looking for ways to make the CA-125 test and transvaginal ultrasound more accurate. Others are investigating completely new methods of early detection, like tumor markers, antibodies, and other tests. Women can find out more about ongoing studies through the American Cancer Society's Clinical Trials Matching Service, or at www.clinicaltrials.gov, the national registry of clinical trials maintained by the US National Institutes of Health.