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Why Ovarian Cancer is Difficult to Diagnose

September 09, 2019

By Dr. Jonathan A. Cosin
Director of Gynecologic Oncology
The Hospital of Central Connecticut

September is ovarian cancer awareness month, so it’s a good time to learn more about one of the more difficult cancers to diagnose.

While ovarian cancer may not be one of the most common cancers among women, it ranks in the top five for cancer deaths. Sometimes referred to as the “silent killer,” ovarian cancer comes with symptoms that are easily mistaken for something much more benign, making it difficult to diagnose early. Four out of five cases are diagnosed at an advanced stage. When identified early, it carries a 90 percent five-year survival rate.

The symptoms of ovarian cancer can be associated with any number of conditions. A woman may experience abdominal bloating, pain in the belly or pelvis, changes in appetite, or urinary urgency and frequency. It’s frustrating that all these symptoms could be tied to a variety of things that run the gamut from nuisance to life-threatening. That’s why it’s critical to get to a doctor if the symptoms persist almost daily for two to three weeks, or grow severe or worsen with time.

A thorough physical and pelvic exam at the doctor’s office may reveal a lump in or on an ovary. A lump may also be detected during an ultrasound. A blood test to measure cancer antigen 125 (CA-125) may be ordered. While elevated CA-125 levels can mean many things, too much CA-125 in the bloodstream can be an indicator of ovarian cancer. It’s important to note that too much CA-125 can also be caused by uterine fibroids, endometriosis, and a woman’s menstrual cycle.

Studies have shown that a woman’s chance of beating ovarian cancer dramatically improve when a gynecologic oncologist is involved in her care. Specially trained to address cancers of the female reproductive system, a gynecologic oncologist will develop the best course of action, which may include a combination of surgery and chemotherapy. Women diagnosed early have an excellent chance of being cured if aggressive treatment is pursued.

Most women diagnosed with ovarian cancer will be offered genetic testing to determine if they have an inherited gene which predisposes them to cancer. This is important for two reasons. In identifying the presence of the gene, patients can inform other family members about possible risk. The genetic testing can also lead to specialized targeted treatments for the patient.

There are a few factors that can reduce a woman’s risk of developing ovarian cancer. Pregnancy is known to reduce a woman’s risk, as does breastfeeding. Oral contraceptive pills and tubal ligation are also associated with a reduced risk of ovarian cancer.

As is true with so many cancers, early detection is key. When the cancer is found early, treatments are more successful. By nature of its stealthy symptoms, most of the time, cancer has already spread by the time of diagnosis. There is no screening test for ovarian cancer. Ultrasounds and CA-125 testing is not recommended for women who have no symptoms.

The most important thing to remember is to listen to your body. Do not ignore changes and symptoms that may point to a more serious condition. Until you see a doctor and have an exam, you’ll never know if it’s truly “nothing to worry about.”

Dr. Jonathan A. Cosin is the director of gynecologic oncology at The Hospital of Central Connecticut. For more information on gynecologic oncology services at the hospital, click here. For more information on cancer, click here.