The symptoms of ovarian cancer can be very vague and non-specific. Symptoms are more likely to occur when the cancer begins to create pressure on other organs in the abdomen, such as the bladder or rectum. Even then, the symptoms may mimic other conditions, such as gastrointestinal distress, back pain or acute illness. About 60% of women have advanced stage disease by the time ovarian cancer is diagnosed because the symptoms often mimic other conditions. Women without a family history for ovarian cancer have about 1.4% risk for developing it or a lifetime risk of 1 in 70.
Possible signs of ovarian cancer:
- Abdominal bloating or discomfort
- Early satiety
- Increased abdominal size or clothes fitting tighter around your waist
- Increased or urgent need to urinate
- Pelvic pain
- Nausea and gas
- Constipation or diarrhea
- Abnormal bleeding
- Unusual fatigue
- Unexplained weight loss or gain
- Shortness of breath
- Enlarged lymph nodes in the groin
Certain factors are associated with an increased risk of getting ovarian cancer. Women have an increased risk if they have had breast, intestinal, or rectal cancer. Women with first or second degree relatives who have had ovarian cancer are at greater risk, reaching perhaps a 50 percent chance if they have at least two first-degree relatives (mother, sister or daughter) with the disease. Women who have a first-degree relative and one or more second-degree relatives (aunt, grandmother) who had ovarian cancer have a somewhat lesser risk than those with two first-degree relatives, but are still considered to be at high risk.
Ovarian Cancer accounts for about 4% of all female cancers. At least 10% of all ovarian cancers are estimated to have a hereditary background according to a recent Swedish study. In 1994, two breast cancer susceptibility genes were identified: BRCA1 on chromosome 17 and BRCA2 on chromosome 13. When individuals carry a mutation of either BRCA1 or BRCA2, they are at an increased risk of developing breast or ovarian cancer at some point in their lives. The abnormal gene can be inherited from either parent. Genetic counseling can predict whether you are likely to have one of the gene mutations associated with an increased ovarian cancer risk. If your family history suggests that you might have one of these gene mutations, genetic testing might be considered.
Although general screening of the population for BRCA1 and BRCA2 is not yet recommended, it is recommended for those at high risk for either breast cancer or ovarian cancer. Cost and insurance reimbursement may be barriers to testing for the mutated genes.
Women often ask about screening for ovarian cancer and what they can do to prevent it. Unfortunately, specific tests have not been developed that allow for consistent early detection of ovarian cancer. A blood test called CA 125 has been discussed frequently on the internet but does not provide reliable results for early detection or screening. In fact, up to 50% of women with stage 1 ovarian cancer have a normal CA 125 levels. Ca 125 levels are often elevated in 1% of healthy women, and up to 40% of women with benign masses.
Another screening technique that is often asked about is pelvic ultrasound. Pelvic (transvaginal) ultrasound can detect some changes, but it is not routinely used to screen for ovarian cancer. In a study completed in 1997 with 14,469 asymptomatic women, researchers detected ovarian cancer in 17 women with the use of pelvic ultrasound. Following surgical removal of the masses, researchers determined that 11 of the 17 cancers were early stage. Because so many women had to be screened in order to find 17 ovarian cancer cases, pelvic ultrasound is not considered an effective and efficient way to screen for ovarian cancer among the general population of women.
If a woman is high risk for ovarian cancer, having a pelvic (transvaginal) ultrasound and a serum (blood) test for CA 125 may be a logical option for screening. Some authorities believe that among high risk women, those with a strong family history of either ovarian or breast cancer, getting a combination of pelvic ultrasound and CA-125 screening 5 years prior to the earliest age of onset in their family member or members should be encouraged. According to some of these authorities, women at high risk for ovarian cancer should have a baseline ultrasound combined with a blood CA-125 measurement, followed by an annual CA-125 measurement and an ultrasound every 2 years. If the CA 125 rises significantly from one year to the next, an ultrasound should be performed more frequently. Women should be counseled that the tests must be considered inconclusive simply because neither pelvic ultrasound nor serum CA-125 are effective or efficient for screening.
Ovarian cancer prevention
Ovarian cancer can sometimes be associated with known risk factors for the disease. Many risk factors are modifiable though not all can be avoided. Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer.
- Age: The risk of developing ovarian cancer increases as a woman gets older.
- Oral contraceptives: Studies suggest that the use of oral contraceptives may reduce the risk of developing ovarian cancer. The longer you use oral contraceptives the lower your risk might be. The decrease in risk may last for a long time after the use of oral contraceptives has ended.
- Childbearing and breast-feeding: Women who have had at least one child are less likely to develop ovarian cancer than women who have never had children. Studies have also shown that women who breast-feed are less likely to develop ovarian cancer.
- Tubal ligation or hysterectomy: Studies have shown that women who have undergone tubal ligation (sterilization) or hysterectomy are at decreased risk of developing ovarian cancer.
- Prophylactic oophorectomy (removal of both ovaries): Sometimes women with a very strong family history of ovarian cancer decide to have prophylactic oophorectomy. However, this has not been proven to avoid the risk of ovarian cancer; and ovarian removal can have unwanted effects.
- Hormone replacement therapy: some forms of hormone replacement therapy may be associated with an increased risk of ovarian cancer in postmenopausal women.
- Fertility drug use may be associated with an increased risk of ovarian cancer.
- Other risk factors that may have a relationship to ovarian cancer are the use of talcum powder in the area between the vagina and the anus and eating a high-fat diet. The relationship between the use of these and ovarian cancer is not completely understood.
Most importantly, become more conscious of your body; be aware of changes that persist and report those to your care provider.
There are a number of web sites available for additional information. Below are a few.
Ovarian Cancer Risk (Bandolier)
Ovarian Cancer (Medline Plus)
Ovarian Cancer Prevention (National Cancer Institute)
Ovarian Cancer (WebMD)