Cancer leg ovarian pain

Ovarian cancer

H E A L T H

Several procedures may be useful

for early detection

ILLUSTRATION BY CAMILLE WEBER

KNIGHT RIDDER/TRIBUNE

BY DR. DEBBIE FIELD-KRESIE

Ovarian cancer is the second most common malignancy of the female reproductive system preceded only by uterine cancer. However, more women die from ovarian cancer than uterine cancer.

In 2003, there were 25,300 women in the United States diagnosed with ovarian cancer and 14,300 deaths from ovarian cancer.

Seventy-five percent of women diagnosed with ovarian cancer have disease that is advanced or spread outside the ovary. Five-year survival in patients with advanced disease is only 20 percent to 30 percent. When ovarian cancer is found in a localized stage, more than 90 percent will live longer than five years. This raises the question, what can women and health care providers do to increase the early diagnosis of ovarian cancer?

Although there is no single screening test that has revolutionized the detection of ovarian cancer in early stages, there are several procedures and recommendations that may be useful for early detection.

Women of all ages should have an annual pelvic exam regardless of whether an annual pap smear has been advised. During a physical exam, the health care provider examines the abdomen, vagina and rectum. According to Dr. David Fisher, the current director of the National Ovarian Cancer Detection program, "The most effective thing physicians can do to detect ovarian cancer is to perform rectovaginal exams on their patients."

Fisher has found that as many as 40 percent of women entering his program haven't had a rectal exam as part of their annual screening. Pelvic exams are also useful for finding other gynecological cancers and conditions.

Women may be symptomatic several months before their diagnosis of ovarian cancer even in early stages of disease. It is a misconception that ovarian cancer is symptomatic only in late disease. A survey of women with early ovarian cancer showed that at least 70 percent had symptoms three months before diagnosis.

Early ovarian cancer can have vague symptoms. These may include pelvic pressure, back pain, leg pain, abdominal swelling and digestive problems, such as gas, bloating and indigestion. The Society of Gynecologic Oncologists advises that, "The best way to detect early ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in the symptomatic woman."

Prompt attention of these symptoms by the patient and health care provider can improve the chance of early diagnosis and successful treatment.

An ultrasound of the ovaries can be used as a screening test for ovarian cancer. It can be ordered if there is a finding on the pelvic examination or if there are symptoms despite a normal pelvic exam. An ultrasound is beneficial because even skilled examiners may not be able to palpate ovarian tumors in the early stages of cancer.

The cancer antigen 125 (CA 125) blood test is mainly used to check for the recurrence of ovarian cancer. This blood test is better for detection of late stage ovarian cancer than early stage. There are many conditions --- such as fibroids, benign ovarian cysts, pelvic inflammation, ovulation and endometriosis --- that may cause a false elevation of the test. For these reasons, the CA 125 blood test isn't a reliable screening test.

In the studies of women with an average risk of ovarian cancer, the routine (yearly) use of ultrasound and CA 125 blood test hasn't been shown to lower the number of deaths caused by ovarian cancer.

A blood test exists that can identify ovarian cancer with 100 percent sensitivity and specificity. The test uses proteomics, the study of proteins inside cells. The test isn't available as a screening tool, but work is in progress to make the test part of the screening process for ovarian cancer.

Patients who are high risk for ovarian cancer such as those with a strong family history, personal history of breast cancer or who are a carrier of a gene mutation for ovarian cancer may be referred to clinics specialized for early detection of ovarian cancer.

Until newer, more accurate screening tests became available, the best test for early detection of ovarian cancer is the annual pelvic examination. Careful attention to symptoms of ovarian cancer by patients and health care providers is also important for early discovery. hk