Ovarian Cancer (cont.)
Exams and Tests
Many exams and tests are used to determine if a woman has ovarian cancer.
Physical exam: Every woman should have an annual pelvic exam in which the health care provider feels (palpates) the ovaries and obtains a Pap smear (Papanicolaou test).
- Although the Pap smear is designed to check for cervical cancer,
there have been some rare cases in which abnormal ovarian cells were
identified with this test.
- Ovaries are normally small, especially in women who
have been through menopause, and are deep within the pelvis. Normal-sized
ovaries are difficult to feel. Because of this, the pelvic exam is not very
effective in detecting early ovarian cancer.
- Masses large enough to be felt may represent advanced disease. More often, they are harmless growths or other noncancerous conditions.
Ultrasound: If a mass is present, the health care provider may recommend an ultrasound examination to find out what kind of mass it is.
- Ultrasound imaging can detect small masses and can
distinguish whether a mass is solid or fluid filled (cystic).
- A solid mass or complex mass (having both cystic and solid components) may be cancerous.
- Incorporating Doppler technology to identify certain patterns associated with tumors seems to improve the usefulness of ultrasound screenings.
- If the ultrasound shows a solid or complex mass, the next step is to obtain a sample of the mass to see whether it is a cancerous tumor.
Many studies have reviewed the value of ultrasound screenings for ovarian cancer of women who have no symptoms. Although ultrasound identified many masses, very few of these masses (about 1 in 1000) were cancerous. Furthermore, many women underwent unnecessary surgeries only to discover benign masses.
CT (computed tomography) scanning: If ultrasound reveals a solid or complex mass, a CT scan of the pelvis may be done.
- A CT scan is a type of x-ray that shows much
greater detail in 3 dimensions.
- A CT scan provides more information about the size and extent of the tumor. It can also show whether the tumor has spread to other organs in the pelvis.
The health care provider also conducts lab tests to gather information about the woman's medical condition and to detect substances released into the blood by ovarian cancers (tumor markers).
The health care provider may request a pregnancy test if there is any chance the woman could be pregnant. Pregnancy can be detected by checking the blood level of beta-HCG, a hormone that increases dramatically during pregnancy.
- Ovarian masses during pregnancy may be associated with ectopic pregnancies (pregnancy outside the womb) or may be normal structures that produce other hormones important in gestation.
The woman's blood will probably also be checked for tumor markers. Health care providers suspicious that ovarian cancer is present usually conduct the CA-125 test.
- The level of the most widely studied tumor marker, CA-125,
is elevated in more than 80% of women with advanced ovarian cancer and in
about 50% of women with early ovarian cancer.
- The level of this marker value can be affected by a number of factors, including age, menstrual status, and conditions such as endometriosis, pregnancy, liver disease, and congestive heart failure.
- Cancers of the breast, pancreas, colon, and lung also
secrete the CA-125 marker.
- Because this marker can be influenced by so many factors that have nothing to do with ovarian cancer, this marker is not generally used for routine screening of women who have no symptoms.
Health care providers do not recommend genetic screening for women with no first-degree relative, or only one relative, with ovarian cancer.
- Women with 2 or more relatives with breast or ovarian
cancer should be referred to a specialist to discuss genetic testing.
- Members of families with hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome II) should also be referred to a specialist.
Paul Blackburn, DO, FACOEP, FACEP
Francisco Talavera, PharmD, PhD
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