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Note: There may be no symptoms of
ovarian cancer until late in the disease.
Women experiencing
above ovarian cancer symptoms
should insist on having a blood test called CA-125
done. While this test is far from perfect, and is
generally not regarded as useful for large scale
screening by the medical community, a high value
will immediately signal the need for further
testing for ovarian cancer. Normal values range from 0 to 35. Values
can be temporarily elevated due to a number of
non-cancerous causes.
CA-125 stands for Cancer Antigen
125. The CA-125 test looks for the presence of a
protein on the surface of cells from the ovary.
Elevated levels of this protein have been associated
with other types of
cancer, but it is considered
a
biomarker for ovarian cancer.
Further screening may involve CT
scans, trans-vaginal ultrasounds, or retesting of
the CA-125 value at a later date.
Signs of
Ovarian Cancer
Physical examination may
reveal increased abdominal girth and /or
ascites (fluid within the abdominal cavity).
Pelvic examination may reveal an ovarian or
abdominal mass. The pelvic exam should
include a rectovaginal component for better
palpation of the ovaries.
Causes of Ovarian Cancer
Ovarian cancer
is the fourth leading
cause of cancer death in women, the leading
cause of death from gynecologic malignancies
and the second most commonly diagnosed
gynecologic malignancy while the exact cause
is unknown (i.e., idiopathic),
ovarian cancer is more common in
industrialized nations,
with the exception of Japan. In the United
States, females have a 1.4 percent to 2.5
percent (1 out of 40-60 women) lifelong
chance of developing ovarian cancer.
Older women are at highest risk
of ovarian cancer death.
More
than half of the deaths from ovarian cancer
occur in women between 55 and 74 years of
age and approximately one quarter of
ovarian cancer deaths occur in women between 35 and
54 years of age.
The risk for developing ovarian cancer
appears to be affected by several factors.
The more children a woman has, the lower her
risk of ovarian cancer. Early age at first
pregnancy, older ages of final pregnancy,
and the use of some oral contraceptive pills
have also been shown to have a protective
effect. Ovarian cancer is reduced in women
after tubal ligation.
The link to the use of
fertility medication has been controversial.
An analysis in 1991 raised the possibility
that use of drugs that stimulate ovulation
may increase the risk for ovarian cancer.
Several cohort studies and case-control
studies have been conducted since then
without providing conclusive evidence for
such a link with the possible exception that
prolonged use (> 1 year) of clomiphene
citrate should be avoided.1 It will remain a
complex topic to study as the infertile
population differs in parity from the
"normal" population.
There is good evidence
that in some women genetic factors are
important. Carrier of mutations of the BRCA1
or the BRCA2 gene are at higher risk of both
breast cancer and
ovarian cancer already at
a younger age. Patients with
a personal history of breast cancer, or a family
history of breast and/or ovarian cancer, may
have an elevated risk. A strong family
history of uterine, colon, or other
gastrointestinal cancers may indicate the
presence of a syndrome known as hereditary
non-polyposis
colon cancer (HNPCC), which
confers a higher risk for developing ovarian
cancer. Patients with strong genetic risk
for ovarian cancer may consider the use of prophyllactic oophorectomy after completion
of their reproductive goal.
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