Ovarian cancer is the fifth most common cause of cancer-related deaths among American women, making prevention and early diagnosis important for women across the United States. Despite their importance, ovarian cancer screening methods are relatively unreliable and make it possible that a woman's diagnosis will be delayed until it is too late for effective treatment. Further developments in ovarian cancer screening are needed to improve diagnostic capabilities and reduce the mortality rate for this disease.
Significance
Ovarian cancer screening is a critical topic in the medical field because this type of cancer is typically not found until it is in its later stages. When the cancer has reached a late stage and spread to other organs, it becomes more difficult to treat. According to the Ovarian Cancer National Alliance, 20,000 women in the United States are diagnosed with ovarian cancer each year. Because there is no reliable screening tool for this type of cancer, 75 percent of those women die from the disease. This high mortality rate makes it important for researchers to continue to search for more reliable ways to screen for this disease.
Problems
One of the contributing factors to the issue of screening for ovarian cancer is that there is no laboratory test or imaging study that can reliably diagnose the disease. CA-125 blood testing is sometimes used in screening for ovarian cancer, but the usefulness of this test is limited by the high possibility of a false positive or false negative result. CA-125 is a protein that is released into the blood by some types of cancer. However, the results of the test can be altered by the presence of endometriosis or pelvic inflammatory disease. If a woman is menstruating, the level of CA-125 in the blood may also be increased. Currently, surgery is the only way to determine if ovarian cancer is present.
Effects
The lack of reliable screening tools for ovarian cancer has several negative effects on women who have been screened for the disease. If a woman's CA-125 level is elevated, the blood test may be followed with a surgical procedure to determine if cancer is present. These procedures are invasive and increase the chances that a woman will develop an infection or experience a reaction to the anesthetic used during the procedure. These procedures are also expensive, which can be a burden for women without insurance or those who have limited insurance coverage. If a woman has a false negative result, the diagnosis of ovarian cancer may be delayed, giving the cancer more time to grow and spread.
Current Screening Methods
The current screening tools for ovarian cancer are pelvic examination, rectal examination, laboratory testing and imaging studies. During a pelvic examination, a physician places two fingers inside the vagina and uses the other hand to press on the abdomen. The doctor may also perform a rectal exam, which allows the ovaries to be felt through the wall that separates the rectum from the vagina. Abnormal masses can be felt during these examinations, giving the doctor more information about a patient's condition. CA-125 testing may be done to determine if levels of the CA-125 protein are elevated. Transvaginal ultrasound, pelvic CT scans and pelvic MRI scans can be done to determine if there are cysts or solid masses on the ovaries.
Surgical Diagnosis
Biopsy is the only way to determine if a mass is benign or cancerous. To obtain a piece of ovarian tissue for a biopsy, surgery must be performed. Laparoscopic surgery can be done to minimize scarring and shorten the recovery period. During a laparoscopic procedure, a thin tube is passed through small incisions in the abdomen. This tube has a camera that displays images of the pelvic organs on a video monitor. Doctors can use small instruments to take tissue samples from the mass. If laparoscopic surgery cannot be done because of the size of the mass or the patient's medical history, a laparotomy can be done. During this procedure, a large incision is made in the abdomen. Once muscle and fat have been pulled back to reveal the ovaries, tissue samples can be taken for a biopsy.
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