Why is it Challenging to Diagnose Ovarian Cancer & What Happens After a Diagnosis of Ovarian Cancer?

Understanding Ovarian Cancer

According to estimates by the American Cancer Society, ovarian cancer is believed to affect over 22,000 women every year. It is also the fifth leading cause of cancer-related deaths amongst women.(1, 2) Unlike other types of gynecologic cancers, there are no screening tests available for ovarian cancer. Some women do get diagnosed with ovarian cancer due to increased levels of the CA 125 protein, but the associated blood test is not accurate enough to diagnose ovarian cancer, as there are many non-cancerous conditions that can increase the levels of CA 125 protein.(3,4,5)

Ovarian cancer is challenging to diagnose in the early stages because of its vague symptoms. Most women may develop symptoms like constipation, early satiety after having food, bloating and back pain. When it comes to postmenopausal women, anyone can be at risk of ovarian cancer. Many factors also increase the risk for the disease, including smoking, polycystic ovary disease, obesity and endometriosis.(6, 7)

Let’s see why ovarian cancer is difficult to detect and what can be done if you feel you may have the symptoms.

Why Is It Challenging to Diagnose Ovarian Cancer?

In most cases, doctors do not find ovarian cancer until it has already progressed to an advanced stage. It is estimated that only about 20 percent of ovarian cancer get diagnosed in the early stages of the disease.(8)

When detected in the earlier stages, tumors are easier to treat and may even be cured. However, many ovarian cancers are usually not detected until they have reached stage 3 or stage 4. At this point, the cancer has already spread inside the pelvic region and sometimes even beyond.(9,10)

Late detection of ovarian cancer puts people diagnosed with the cancer at a greater disadvantage because of how quickly the cancer has spread by the time of detection.

There are many reasons why it is difficult to detect and diagnose ovarian cancer in its early stages. Here are some of the main reasons:

  1. Ovarian Cancer Causes Vague Symptoms

    Ovarian cancer was earlier referred to as a silent killer because the early symptoms presented by this cancer are usually challenging to detect and diagnose. However, ovarian cancer is not really silent. Symptoms may occur in the early stages, but they are more likely to be ignored or believed to be related to something else.

    In 2012, a study done by the University of Washington explained the following symptoms of ovarian cancer:(11)

    • Pain or pressure in the abdomen
    • Abdominal bloating
    • Back pain
    • Menstruation changes
    • Feeling unusually full after a meal
    • Feeling full quickly or having difficulty eating
    • Changes in urination (this can include an increase in the frequency of urination or the feeling of the need to urinate frequently)
    • Painful intercourse

    If any of these symptoms continue to persist or you experience them for over 12 times in a month, you should schedule an appointment with your doctor to get a proper diagnosis for what’s going on in your body.(12)

  2. Pelvic Examinations Are Rarely Able To Detect Cancer In The Early Stages

    The ovaries are located deep inside your abdominal cavity. This makes it difficult to feel an enlarged area or lump. In some cases, doctors are not even able to detect an abnormality while carrying out a pelvic examination.

    Imaging tests are usually used to find tumors. But, usually, doctors do not prescribe these tests without having a suspicion of a tumor, making it more important not to ignore the symptoms or changes in the body, especially if they are persistent.(13)

  3. Lack of Any Screen Tests

    To detect colon cancer, doctors use a screening test known as a colonoscopy. A Pap smear test is used for detecting cervical cancer. However, there is no individual screening test for detecting ovarian cancer.

    Research is ongoing on finding possible screening tests for ovarian cancer, but as of now, there is no single test that is used to detect the presence of ovarian cancer.(14)

    In 2018, a guideline was released by the US Preventive Services Task Force that stated that the risks of possible screening tests are far too great to make a case for any potential benefits.(15)

    Instead of a screening test, doctors have to primarily rely on physical examinations and self-reporting of symptoms from patients to find ovarian cancer.

How is Ovarian Cancer Diagnosed?

As mentioned above, there is no screening test to detect ovarian cancer. Similarly, there is also no single test that can diagnose ovarian cancer. Instead, a doctor has to rely on results from several tests to find out if there is a tumor growing inside an ovary. If a tumor is found, there are other tests that are carried out to determine if the tumor is cancerous or not.

Some of the common diagnostic tests that are used for detecting ovarian cancer include:

  • Physical Pelvic Examination: During a physical exam of the pelvic region, a doctor will feel your abdomen and pelvic region to check for any signs of enlarged ovaries.
  • Blood Test: There are some blood tests that are done to detect a specific biomarker. Cancer antigen 125 or CA-125 is the biomarker that is typically found to be quite elevated in people with ovarian or fallopian tube cancer. However, there are some other health conditions as well that can lead to increased levels of CA-125. This is why it is not considered to be a definitive blood test for ovarian cancer.
  • Transvaginal Ultrasound (TVU): During a transvaginal ultrasound, a doctor will place a small instrument inside the vagina. This device sends back images of the fallopian tubes, uterus, and ovaries. A TVU ultrasound can only check for growth, but it cannot determine if they are cancerous or not.
  • Surgical Staging: This is like a cancer biopsy. A surgeon will take out some tissue from the ovaries to take a biopsy of the tissue’s tumor. The biopsy will determine if the tumor is cancerous. This type of biopsy is usually done during the surgery itself to remove all of the visible cancer. (16, 17)

If these diagnostic tests suggest that you might have ovarian cancer, and a biopsy further confirms that the tumor is cancerous, your doctor may order further tests to determine if the cancer has spread to other places from the ovaries. These tests may include:

Why Does Regular Screening Not Work For Ovarian Cancer?

There are some forms of cancer for which doctors keep screening regularly. These include skin cancer, breast cancer, colon cancer, prostate cancer and many others. However, there is no regular screening for ovarian cancer.

In 2016, a study carried out by the University of Pennsylvania School of Medicine discovered that people having an average risk of ovarian cancer who underwent a transvaginal ultrasound and had a CA-125 blood test ended up having many more testing and unnecessary surgeries.(18) This additional testing and screening did not lower the number of deaths caused by ovarian cancer. Neither was it successful in detecting ovarian cancer in people at an early stage.

In those who have a higher risk of developing ovarian cancer, genetic testing might add some value in determining the predisposition towards this type of cancer.(19) It has been found that people with the BRCA1 and BRCA2 gene mutations or any other gene mutations have a greater risk for ovarian cancer.

However, again, not everyone with these gene mutations will go on to develop the cancer.

Screening for ovarian cancer can also be too expensive, which is another reason why regular screening for this type of cancer is not commonplace.

Instead of regular screening, genetic testing and counseling are often recommended after an ovarian cancer diagnosis is made. This information can help the cancer care team come up with the best treatments while also understanding the risk factors of the patient for other health complications.

What Happens After A Diagnosis Of Ovarian Cancer?

If your doctor suspects ovarian cancer, they will refer you to a gynecologic oncologist (GO). These specialist doctors help diagnose, analyze, and treat ovarian cancers. In 2021, a study done by the US-based Centers for Disease Control and Prevention stressed the importance of receiving treatment from a proper gynecologic oncologist to increase the overall rate of survival amongst women with ovarian cancer.(20)

Your gynecologic oncologist may also prescribe more tests to determine if the tumor is present and if it is cancerous or benign. These tests will also help them find out if the cancer has spread beyond the affected ovary or ovaries.

In case ovarian cancer is diagnosed, you will start treatment at the earliest. Surgery is typically the recommended course of treatment. During this type of surgery, the gynecologic oncologist is most likely to remove the ovaries, uterus, and fallopian tubes. Chemotherapy is also a common treatment for ovarian cancer. Additional surgery might be needed afterward to remove any affected lymph nodes and tissues in the pelvic and abdominal regions.(21, 22, 23)

Conclusion

Ovarian cancer can be challenging to detect in its early stages. However, it is not entirely impossible. It is important for people at a high risk of ovarian cancer to realize that early detection is important for successfully treating the cancer. As there is no regular screening for ovarian cancer, if you doubt that you might be having ovarian cancer, your doctors will run several tests to help diagnose what is going on, depending on your symptoms.

This is why it is so important to pay close attention to any symptoms or changes in your body and make an appointment with the proper doctor to help you get to the root cause of the symptoms.

References:

  1. Cancer.org. 2021. Ovarian Cancer Statistics | How Common is Ovarian Cancer. [online] Available at: <https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html> [Accessed 15 October 2021].
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  3. Karabudak, A.A., Hafner, J., Shetty, V., Chen, S., Secord, A.A., Morse, M.A. and Philip, R., 2013. Autoantibody biomarkers identified by proteomics methods distinguish ovarian cancer from non-ovarian cancer with various CA-125 levels. Journal of cancer research and clinical oncology, 139(10), pp.1757-1770.
  4. Hefler, L.A., Concin, N., Hofstetter, G., Marth, C., Mustea, A., Sehouli, J., Zeillinger, R., Leipold, H., Lass, H., Grimm, C. and Tempfer, C.B., 2008. Serum C-reactive protein as independent prognostic variable in patients with ovarian cancer. Clinical cancer research, 14(3), pp.710-714.
  5. Ferraro, S., Braga, F., Lanzoni, M., Boracchi, P., Biganzoli, E.M. and Panteghini, M., 2013. Serum human epididymis protein 4 vs carbohydrate antigen 125 for ovarian cancer diagnosis: a systematic review. Journal of clinical pathology, 66(4), pp.273-281.
  6. Jayson, G.C., Kohn, E.C., Kitchener, H.C. and Ledermann, J.A., 2014. Ovarian cancer. The Lancet, 384(9951), pp.1376-1388.
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  8. Cancer.org. 2021. How to Check for Ovarian Cancer | Ovarian Cancer Screening. [online] Available at: <https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html> [Accessed 15 October 2021].
  9. Colombo, N., Van Gorp, T., Parma, G., Amant, F., Gatta, G., Sessa, C. and Vergote, I., 2006. Ovarian cancer. Critical reviews in oncology/hematology, 60(2), pp.159-179.
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  12. Cancer.org. 2021. Signs and Symptoms of Ovarian Cancer | Early Signs of Ovarian Cancer. [online] Available at: <https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/signs-and-symptoms.html> [Accessed 15 October 2021].
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