FAQs

My mother-in law, a really energetic woman in her late 60s, was recently diagnosed with ovarian cancer. The only symptoms she had to let her know that she might have had a problem were a bit of mild indigestion and some tummy bloating-which she put down to putting on some weight.

Apparently her mum died in her 60's from liver cancer,and her specialist seems to think that there was a good chance from the story that she might have had ovarian cancer too. She's now had her surgery and chemotherapy and seems to be doing really well, but I have a couple of questions. She had a Pap test and pelvic examination only 3 months before her cancer was discovered and nothing was picked up by her doctor. Surely she should have had a test to screen for the ovarian cancer then, rather than waiting until it caused problems? I'm only 40, but should I be talking to my doctor about screening for ovarian cancer too? What about my two sisters-in-law who are in their late 40s?

Answer

I'm sorry to hear about your mother-in law and I'm pleased to hear that she is now feeling better. The risk of a woman living in Australia getting ovarian cancer at some time in her life is about 1 in 108.

Unfortunately most ovarian cancers are diagnosed only after the woman gets some sort of symptom - by which time the tumour has often already spread and the chances of a full recovery are less. The symptoms themselves are often as low-grade as your mother-in -law found, and can include such things as abdominal bloating, a feeling of fullness after a meal, loss of appetite, weight loss, loss of energy, lower abdominal pressure and a whole range of other non-specific bowel or urinary symptoms. Since all these symptoms are are found in lots of other medical conditions it can be difficult for doctors to make the correct diagnosis early.

One would think that it would make a lot of sense then to test women for this cancer when they have their regular well-woman tests every two years- before they actually get any symptoms and before the cancer had had a chance to spread. The main problem is that the tests for ovarian cancer we have at the moment just aren't accurate enough for them to be all that useful to use as a general screening test in well women in the same way that doctors presently recommend routine Pap tests for all sexually active women, or mammograms for women over 50.

Another problem is that there is actually not one " ovarian cancer" but several different kinds -some of these cancers are extremely agressive and can spread to other organs almost as soon as the cells start to change. This probably occurs in some cases before they could be picked up on any of the tests for ovarian cancer that doctors now use to make this diagnosis.

The tests presently available to help doctors to diagnose ovarian cancer are :

1.Transvaginal and abdominal ultrasound - this can be a sensitive test when the ovary is actually enlarged by the cancer. Unfortunately it also picks up lots of other causes for ovarian enlargement (cysts, benign growths). The other thing is that some ovarian cancers do not enlarge the ovary at all, but begin straight away as small multiple cancers scattered over the lining of the abdomen. Ultrasound is unlikely to pick these up at all .

Another test, Magnetic Resonance Imaging (MRI), would appear to offer a more promising option for the future in terms of accuracy , but doctors as yet don't yet have much experience with this test. It is also extremely expensive and while it may be useful to check whether something detected on other tests is likely to be a cancer, it's probably unlikely ever to be recommended as a screening test.

2.CA 125 and CA 19.9 . These are blood tests for some substances that an ovarian cancer can make.The problem with these tests is that there are a whole range of other reasons why they might be elevated, especially in women who have not yet gone through the menopause. One of the common causes for an elevated CA125 for instance is endometriosis.So while it can be reassuring if these so called "tumour markers" are low, if they are found to be high then many women who don't have ovarian cancer might have to undergo major surgery to prove this.

3.General tests for 'wellness' eg Full blood count and tests for liver function .These may show changes if someone has a cancer that has spread beyond the ovary-but again this won't be terribly useful as a screening test.

The present Australian recommendations are that regular screening is only recommended for women at higher risk of getting ovarian cancer. Having one close relative with ovarian cancer doubles the risk that a woman will develop the disease, and having two affected relatives increases it nearly 4 times. Your two sisters-in law probably fit into this group, and they should ask, if they haven't already, that their doctors refer them for genetic counselling and advice. It is usually recommended that these higher risk women have six monthly ultrasounds and at the same time that they have CA 125 blood tests. Having said that, 95% of women who actually get ovarian cancer have no obvious genetic risks for the disease.

It is interesting to note that the single most effective thing that a woman can do to protect herself from getting ovarian cancer is to go on the Combined Oral Contraceptive Pill. Using the Pill for 6 or more years reduces the risk of ovarian cancer by 60% and its protection lasts for up to 10 years after a woman stops taking it.

There is no doubt ovarian cancer is a terrible disease, and the fact that it is usually diagnosed after it has already spread makes it particularly worrying to a lot of women. At present the focus in Australia is to educate women about possible symptoms and to get their doctors to think of ovarian cancer when women come to them with the fairly vague symptoms described above .

You'll also be pleased to know that medical researchers are putting a lot of energy into developing more effective and less costly tests for screening and early diagnosis of this disease. Perhaps in the future this will mean we can all look forward to an accurate and easy test for ovarian cancer that we can simply ve at the same time as our regular Pap test and breast checks.