Ovarian Cancer: 'The Whispering
Ovarian cancer...it whispers...so listen."
So advises the National Ovarian Cancer Coalition, a US group
of 9,000 survivors who want you to know how elusive --and deadly--
the disease can be.
In its earliest stages, ovarian cancer is curable.
Early signs and symptoms are so vague that most women ignore
them and then, unfortunately, are already in the late stages
of the disease when theyre diagnosed. Thats why
its so important for women to listen to their bodies.
Read on to learn the risk factors for ovarian cancer, what you
can do to reduce them, and how you can detect the warning signs.
Are you at risk?
The major risk factors for ovarian cancer fall into three categories:
hormonal, environmental, and genetic.
On the hormonal level, the risk may be directly
related to the number of ovulatory cycles in a womans
life. The postulated theory is that the uninterrupted cell division
and regeneration of the ovarian epithelium--without pregnancy-induced
rest periods--may invite mutation and malignancy. Therefore,
women whove had no pregnancies are at an increased risk.
Infertility also may be a risk factor because childless women
whove been pregnant show the same risk as women whove
never been pregnant. The risk for ovarian cancer peaks in the
eighth decade of life.
We know less about links between environmental
factors and ovarian cancer. Industrialized countries report
the highest incidence; developing countries report the lowest
incidence, but we dont know why. Lifestyle factors such
as diet and exercise are being studied. Cosmetic use of talc
in powders used to dust the perineum, in feminine hygiene sprays,
and on sanitary napkins or condoms has been identified as a
Nothing alters the magnitude of risk for ovarian
cancer more than genetics. Hereditary ovarian cancer syndromes
account for 5% to 10% of ovarian cancers. In general, the closer
the degree of relative and the younger the relative at diagnosis,
the higher the risk.
Research is ongoing in all these areas and
continues to provide us with new information.
You can do something to reduce the
risk of ovarian cancer. Oral contraceptives taken in combination
for longer than 5 years may reduce your risk. A tubal ligation
or hysterectomy surgery may be protective. And pregnancy and
breast-feeding seem to provide some protection. Women who use
powder should use only cornstarch-based products.
Contrary to what you may have heard, ovarian
cancer does present with signs and symptoms. Unfortunately,
they can be so general--lower abdomen discomfort, dyspepsia,
and early satiety, for example--that you dismiss them. The most
important message I can convey is: Dont ignore any persistent
The classic pelvic examination--during which
the clinician searches for palpable ovarian masses-- is the
starting point for a diagnosis of ovarian cancer. In premenopausal
women, enlarged ovaries are common and usually are caused by
ovarian cysts. The clinician usually follows the mass through
several menstrual cycles.
In premenarchal children and adolescents and
postmenopausal women, a palpable ovarian mass isnt normal
and must be investigated with a CA-125 tumor antigen blood test
and a transvaginal ultrasound. Color Doppler imaging studies
also may be used to measure blood flow patterns to ovarian vessels.
Increased blood flow resistance signals a malignancy.
If these studies document an abnormality, the
next step is a computed tomography scan of the abdomen and pelvis,
possibly followed by a barium enema or a colonoscopy.
The CA-125 tumor antigen is associated with
ovarian cancer. In fact, 80% or more of women with ovarian cancer
have an elevated CA-125 level. The problem is that its
also elevated in some benign diseases and other malignancies
as well, so its not specific enough to detect the disease.
The CA-125 tumor antigen has a role in indicating early treatment
failure, confirmation of relapse, and in decision making during
relapse therapy in ovarian cancer.
Surgery--generally a total abdominal hysterectomy
and bilateral salpingo-oopherectomy--is the mainstay of treatment
for ovarian cancer. A major goal of surgery is to stage the
disease and to improve the patients response to chemotherapy,
which follows surgery.
The earlier the stage of the cancer, the better
the chance of a cure. Low-risk patients may need no further
therapy after surgery. High-risk patients must receive postoperative
chemotherapy. The preferred regimen includes carboplatin and
About 75% of ovarian cancer patients achieve
a complete remission after surgery and chemotherapy. However,
most of these patients have a recurrence of their disease within
Hope for the
Research is ongoing to find better methods
to prevent, detect, and treat this tragic, silent disease. The
National Institutes of Health has committed $90 million for
ovarian cancer research, and the National Cancer Institute has
awarded $29 million in research grants.
The future may offer gene therapy, an improved
CA-125 test or a new tumor marker, an ovarian cancer treatment
vaccine, and new types of chemotherapy or immunotherapy.
For now, women must learn to listen to their
bodies, notice even subtle changes, and report them to a clinician
who will listen to the whisper and take action.
Virginia R. Martin is clinical director
of ambulatory care at Fox Chase Cancer Center in Philadelphia.