Ovarian cancer makes me angry.

Ovarian cancer makes me angry.  Symptoms are vague, which means it is often diagnosed at a late stage and there are limited therapeutic options available for treatment.  It’s not fair.

Let’s look at the symptoms:

  • Bloating
  • Feeling full quickly
  • Pain or pressure in the abdomen/pelvis
  • Abnormal vaginal bleeding

My guess is you have experienced all of these at some point in your lifetime. No big deal, right? This is one of the reasons ovarian cancer is often called the silent killer.  Additionally, many women are under the misconception that their yearly pap smear screens for ovarian cancer.  I am here today to tell you: it doesn’t.

There are no general population screening guidelines for ovarian cancer. Transvaginal ultrasound and CA-125 blood tests are the two most common ways that doctors screen for ovarian cancer in patients with an elevated risk. Transvaginal ultrasound provides an image of the ovary.  Think of it as a sort of mammogram for the ovary.  It can detect ovarian cancer early. CA-125 is a protein that is elevated in roughly 90% of ovarian cancers but can sometimes be elevated in patients without ovarian cancer.  CA-125 is generally considered more informative once a patient is diagnosed with cancer as elevations over time can indicate recurrent disease or some other change worth investigation by a patient’s oncologist.

Both transvaginal ultrasound and CA-125 blood tests have limited clinical utility, but they are all we have right now. For more on risk factors and screening guidelines, check out this easy to read and understand information guide from a world leader in cancer care, Memorial Sloan Kettering Cancer Center.

One fact that all patients with ovarian cancer should know is that the National Comprehensive Cancer Network’s guidelines clearly state that all patients with epithelial ovarian, primary peritoneal or fallopian tube cancers meet criteria for BRCA testing, regardless of age.

All patients with epithelial ovarian, primary peritoneal or fallopian tube cancers meet criteria for BRCA testing, regardless of age.

The general population carries up to a 1.5% risk of developing ovarian cancer in their lifetime. Women positive for a BRCA mutation carry up to a 44% lifetime risk of ovarian cancer. One in eight patients who have ovarian cancer will test positive for a BRCA mutation and that information can be used to:

  • Follow very specific serial sectioning guidelines for the tumor of a BRCA positive patient,
  • Guide treatment decisions,
  • Build a personalized management plan, and
  • Empower family members, hopefully preventing an ovarian cancer diagnosis in future generations of a patient’s family.

Even in this day of on-demand information, only 25% of all patients with ovarian cancer know their BRCA status and the overwhelming majority of ovarian cancers are diagnosed when distant metastasis are present.

As a healthcare world, we are not doing a great job at identifying and offering testing to this patient population. Hopefully celebrity stories like Angelina Jolie’s will help, but that is not enough. There is so much work to be done to educate and raise awareness about this disease.  Spread the word. Get the facts. Be empowered.

 

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