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“Ovarian cancer is the fifth leading cause of cancer death in women and there are about 25 thousand new cases a year,” says Dr. John van Nagell, director of gynecologic oncology and American Cancer Society professor of clinical oncology at the University of Kentucky Markey Cancer Center. 

Awareness is important especially because there is not a direct screening test.  “It is a huge misconception that a pap smear detects ovarian cancer.  The problem with the disease is that the majority of the time it is diagnosed in the later stages of 3 and 4,” says Elizabeth Jordan, program director at Ovarian Awareness of Kentucky.  Doctors stress to not rely on the pelvic exam for ovarian cancer detection.  “You cannot reliably diagnose early changes in ovarian volume or structure by a pelvic exam,” says van Nagell.  “Everything feeling normal does not protect against ovarian cancer.”  

The actual signs of ovarian cancer are general in the regard that many women experience them once a month or as part of getting older.  This makes it important to understand what is normal for you.  “Symptoms are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, urgency or frequency of urination, fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities,” says Jordan.  The problem is that these symptoms are found equally in women without the disease.  They are most concerning in postmenopausal women with sudden onset.

If you have experienced symptoms almost daily for more than a few weeks, it is time to talk to your doctor.  “If you are symptomatic or high risk for ovarian cancer, experts recommend a bimanual pelvic rectal exam in which the physician inserts a finger into the rectum and vagina simultaneously to detect abnormal swelling and tenderness; a CA125 blood test; and a transvaginal sonogram,” says Jordan.  The transvaginal sonogram is painless and takes less than ten minutes. 

Unfortunately, none of these three tests are sufficient enough to diagnose early stages.  “The CA125 test is not too reliable in detecting early stage ovarian cancer.  It is only positive in about 40 percent of stage 1 ovarian cancers,” says van Nagell.  The hope is that with the combination of all three tests, there is a good chance that doctors can accurately predict the risk of ovarian cancer.
 
Do not wait until the disease progresses to show up at the doctor’s office.  “Seventy-five percent of women present with stage 3c disease out of 4 stages,” says van Nagell.  In stage 1, the tumor is confined to the ovary.  In stage 2, it is confined to the pelvis.  In stage 3, it has spread beyond the ovary to involve the abdominal structures.  Stage 3c involves peritoneal metastases beyond the pelvis that are greater than two centimeters or lymph node metastases.   “There is no prevention because we do not know what causes ovarian cancer,” says van Nagell.  Early detection makes a world of difference.  “If the disease is detected at stage 1, the five year survival rate is over 90 percent versus a five year survival rate of only 30 percent in a patient with stage 3c disease,” says van Nagell.

Do what is in your power to decrease your risk.  “Risk factors for ovarian cancer include the use of talcum powder in the genital area and eating a high fat diet,” says Jordan.  If you have your ovaries removed or a hysterectomy, you can still get ovarian cancer because it leaves cells behind.  “You can reduce your risk by having at least one child, breastfeeding and using oral contraceptives,” says Jordan.  Pregnancy protects against ovarian cancer because it gives the ovaries a rest.  “If you take oral contraceptives for five years in your twenties and thirties, you reduce your lifetime risk for ovarian cancer by about a half,” says van Nagell. 

Some factors are known to increase your risk.  “Increasing age, personal or family history of breast, colon or ovarian cancer and never being pregnant increase risk,” says Jordan.  If you are asymptomatic over age fifty or are over age twenty-five with a documented family history of ovarian cancer, you can be screened at the University of Kentucky’s ovarian cancer screening program, which was the first of its kind.  They provide free screening to about 15,000 women a year. 

The medical community hopes for a diagnostic test to be available in the near future.  “We and other centers are working hard to develop blood tests as well as sonographic techniques which we hope will continue to promote early detection,” says van Nagell.  There is also research going on about optimal ways to give chemotherapy, which is usually part of treatment in addition to taking out the tumor in what is called staging.

The key to fighting ovarian cancer is raising awareness in the community.  “We hope that if we cannot eliminate it, we want to detect it early when it is curable,” says van Nagell.  Paying attention to your body can be lifesaving.  “It is a silent killer,” says Jordan.  “It whispers and we tell people you really have to listen.  Women have to be their own advocates.”