October 26, 2007

Doctor’s Corner
By Dr. Eduardo Grunvald, M.D.

Ovarian Cancer, One of Those Silent Killers

Ovarian cancer is one of those “silent killer” diseases because it can grow and spread without any symptoms until it is too late. Even when symptoms appear, they can be so common and non-specific that doctors and patients alike can ignore them or forego appropriate investigation. While maintaining an often-difficult balance of informed alertness and undue alarm, women should be aware of the warning signs and stay in tune with their bodies.

According to the National Cancer Institute (NCI), in 2007 over 22,000 cases of ovarian cancer will be diagnosed in the United States, and there will be over 15,000 deaths from this disease. In fact, it is the leading cause of death from gynecologic cancers in this country. A woman’s risk of ovarian cancer usually rises after the age of 55.

Although Hispanic women are not necessarily at higher risk of developing ovarian cancer, according to the NCI, they generally do not receive aggressive enough surgical therapy, mostly explained by poor access to medical centers with adequate experience in treating this cancer. Usually treatment involves a combination of surgery and chemotherapy, and in some cases radiation.

The ovaries are small glands nestled within a woman’s pelvis on either side of the womb. In addition to playing a pivotal role in the intricate cascade of hormones that cycle monthly in women of childbearing years, they produce the eggs that eventually become fertilized at conception.

In its early stages small tumors can grow without any pain or other warning symptoms. Since they lay in the pelvis, adjacent to the cavity and lining of all the abdominal organs, tumors that form on the ovaries can grow and spread from the glands, causing uncomfortable symptoms related to other areas, most notably the intestines and bladder.

The following are warning symptoms that women should get checked out by a doctor if they persist or cannot be explained by other conditions:

- abdominal or pelvic bloating

- persistent pelvic pain, abdominal pain or low back pain

- new constipation or other abnormal bowel habits

- loss of appetite or unexplained weight loss

- new, persistent and unexplained urinary problems

- abnormal vaginal bleeding, especially after menopause

Your doctor will probably perform a pelvic examination and order an ultrasound or other radiological test such as an MRI. In fact, women who still have their ovaries should have periodic pelvic exams as part of a routine physical, even if they don’t need a pap smear (for example, women who have had their uterus removed, or older women who don’t need pap smears frequently).

Sadly, advanced ovarian cancer is usually incurable, despite aggressive treatment. Catching it early improves one’s chances of survival. There are less common cases of ovarian cancer where there is a genetic predisposition – if there are family members with ovarian cancer, especially if diagnosed at an early age, or several relatives with the disease - and women with this family history should be screened and examined by a gynecologist regularly. Women with a history of breast or colon cancer may also have an elevated risk. If you fall into any of these categories discuss your concerns with your doctor.

Right now there is no good screening test for the disease, but a blood test called CA-125, used to monitor response to treatment, may be used for screening in women considered to be high risk. The problem is that in most women the results are usually not reliable enough. Ongoing research is looking at better ways to detect this disease at earlier stages and develop better treatments.

For now however, the best line of defense is to get regular check-ups as directed by your doctor, learn the warning signs and listen to your body.

Dr. Grunvald is Associate Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.

Return to the Frontpage