Detecting ovarian cancer early

Ovarian cancer is the sixth leading cause of cancer deaths in women, according to the National Cancer Institute (NCI). Yet screening tests have not been proven to lower the risk of death from the disease. That’s part of why education and awareness are critical ways you can help protect yourself.

Understanding ovarian cancer

Your ovaries lie deep within your pelvis, which makes disease detection tricky. And although routine pelvic exams include checking for anything that feels out of the ordinary, early-stage ovarian tumors easily escape detection because they’re difficult to feel during an exam. Ovarian cancer is considered to be “silent,” because symptoms tend to be either vague or nonexistent until the disease has spread.

The best way to detect ovarian cancer early is to know the signs and be alert to changes in your body, according to the American College of Obstetricians and Gynecologists (ACOG). If you notice any unusual changes that could be a symptom of the disease, it’s important to see your healthcare provider (HCP) to be checked.

If ovarian cancer is detected early before it has spread, the five-year survival rate (the percentage of people who are alive five years after being diagnosed with ovarian cancer) is more than 90 percent, according to the NCI. Even if it has spread beyond the initial tumor but has not yet spread outside the pelvic area, the five-year survival rate is more than 70 percent. But the vast majority of ovarian cancers are diagnosed when the cancer has spread to distant parts of the body, at which point the chances of survival are significantly reduced. Just over 30 percent of people diagnosed at this point survive more than five years after diagnosis.

Research is underway to develop new, more accurate methods of detecting ovarian cancer early.

Four important symptoms

The following four symptoms are the most common early warning signs of ovarian cancer, according to the American Cancer Society (ACS):

• Abdominal or pelvic pain
• Bloating or abdominal distension
• Early satiety (feeling full quickly) or difficulty eating
• Feeling an urgent need to urinate, or increased frequency of urination

Keep in mind that these are all common symptoms of other health conditions. If you experience some of these issues, it does not necessarily mean that you have ovarian cancer.

It’s important to note if these symptoms are new, persistent, unusual for you, happen more often, or are more intense than normal. The ACS recommends counting any occurrences of these symptoms. If they are new to you and happen more than 12 times a month, it’s time to see your HCP.

Additional symptoms associated with ovarian cancer can include:

• Abnormal vaginal bleeding, especially after menopause
• Back pain
• An upset stomach (such as diarrhea and nausea)
• Fatigue
• Menstrual irregularity
• Painful intercourse
• Swelling of the abdomen with weight loss
• A change in bowel habits

A diagnosis of ovarian cancer is not made based on symptoms alone. But by defining symptoms and raising awareness, people may be encouraged to listen more closely to their bodies and establish an ongoing communication with their HCPs.

Testing for ovarian cancer

The tests used most often to look for early ovarian cancer are done in addition to a manual pelvic exam (when your HCP inserts two gloved fingers into your vagina, then presses gently on your lower abdomen with the other hand to examine your pelvic organs). They are:

• A blood test that measures the level of cancer antigen 125 (CA-125), a protein produced by ovarian cancer cells
• A transvaginal ultrasound, an imaging exam in which an instrument is inserted into the vagina and sound waves are used to view the organs in the pelvic area

Elevated levels of CA-125 could be a sign of ovarian cancer but may also be caused by something else, such as pelvic inflammatory disease (infection of the female reproductive organs) or endometriosis (when cells that line the inside of the uterus grow outside the uterus). What’s more, not everyone with ovarian cancer has high levels of CA-125.

A transvaginal ultrasound (TVS) can detect a mass in the ovary, but most of the time these masses are not cancer.

The two tests carry a lot of uncertainty. They are not shown to reduce ovarian cancer deaths and are not recommended for routine ovarian cancer screening.

Be your own advocate

Screening for ovarian cancer is not yet a routine part of preventive healthcare. But if you have concerning symptoms, in addition to some of the following risk factors identified by the CDC, make an appointment with your HCP right away:

• You’re middle-aged or older
• You have a family history of ovarian cancer in close family members on either side of your family
• You have a genetic mutation called breast cancer 1 gene (BRCA1) or breast cancer 2 gene (BRCA2), or one that is associated with Lynch syndrome (a hereditary condition that increases your risk for colorectal cancer and increases the risk for many other cancers)
• You’ve had colon, breast, or uterine cancer
• You have endometriosis
• You have an Eastern European or Ashkenazi Jewish background
• You’ve never given birth or have had trouble getting pregnant
• You’ve taken the hormone estrogen by itself for 10 or more years

Research suggests many ovarian cancers start in the fallopian tubes, which connect the ovaries to the uterus. If you’re planning to have tubal ligation ("getting your tubes tied," surgery to cut and seal the fallopian tubes to permanently prevent pregnancy) or another gynecologic surgery, you might want to ask your HCP about removing the tubes, rather than tying them off. This procedure, called a complete salpingectomy, may lower your risk of ovarian cancer.

Don't ignore unusual or painful symptoms. And if you feel you're not being taken seriously or your care is not as thorough as you'd like, consider getting a second opinion.

The future of testing

Scientists are developing ways to improve earlier identification of ovarian cancer. Here are the main avenues of research:

Blood biomarkers

These are molecules found in blood that can signal a health condition. They may help detect early-stage ovarian cancer, either by themselves or when used with CA-125. One biomarker, a protein called human epididymis protein (HE4), may improve the ability to figure out whether a mass is cancerous when combined with CA-125.

Autoantibodies

These are proteins made by the immune system that attack our own cells by mistake. They are stimulated when even small volumes of cancer are present, so they could help indicate cancer. Testing for panels or groups of autoantibodies is currently being studied as a complementary screening tool.

MicroRNAs

Molecules that float around in body fluids, microRNAs change based on your state of health. Early research indicates they may be potential biomarkers.

Circulating tumor DNA (ctDNA)

Testing for this might also be a way of detecting tumors. However, this method can give false positives (a positive test result when disease is not actually present) and isn’t as helpful in the early days of the development of a cancer.

DNA methylation-based screening

In many people with ovarian cancer, genes have often been hypermethylated. This turns off genes that usually help prevent tumors, allowing cancer cells to grow out of control. If confirmed in larger studies, blood tests for DNA methylation-based screening may be useful in ovarian cancer diagnosis.

Other imaging technology

Since ovarian tumors can stay very small (less than 3 millimeters) for several years, they can be hard to see with transvaginal ultrasound. This is where other imaging technology might be able to help, such as magnetic resonance imaging (MRI, which uses radio waves to take images of the inside of the body).

While tools for early detection continue to be refined, you can learn to recognize possible symptoms, know your risk factors, and work with your HCP to understand what tests are right for you. If you have questions about ovarian cancer and what diagnostic tests are covered by your insurance, speak with your HCP.