Screening for Ovarian Cancer – Fantasy or Reality?
Epithelial ovarian cancer is generally detected late, with overall five year survival of 20-30%. The search for a cheap, accurate screening test to identify the disease in its early stage has been ongoing for the past few decades. Currently, there is no proven strategy for the early detection of cancer that decreases ovarian cancer mortality.
In the most recent joint Committee Opinion, ACOG and SGO makes the following statement regarding direct-to-consumer marketing of ovarian cancer screening tests
At this time, there is insufficient evidence to support the use of any of these tests or algorithms for the early detection of ovarian cancer in average-risk women. Women considering purchasing these tests, which are currently not approved nor cleared by the U.S. Food and Drug Administration for ovarian cancer screening and are not financially covered by medical insurance, should be counseled on the risks of such tests.
Low Risk and Asymptomatic
Do not use transvaginal ultrasound and tumor markers for ovarian cancer screening
These tests are ineffective, lacking good sensitivity, specificity, and positive predictive value
Including those with a BRCA mutation or a positive family history for ovarian cancer
Refer for genetic services for risk assessment, counseling and management
There is professional guidance regarding ovarian cancer screening for women at high risk which will include biomarker testing and imaging that is regularly reviewed and updated as required
Although ovarian cancer has been described as “silent”, it is not uncommon for women with the disease to have abdominal symptoms. Persistent and progressive bloating, abdominal/pelvic pain, early satiety, appetite loss, urinary urgency, increased abdominal girth should be evaluated with a high index of suspicion for malignancy.
When a pelvic mass has been identified on examination and imaging, consider referral to or consultation with a gynecologic oncologist when
The patient is postmenopausal, the CA-125 is elevated, there is ascites, a nodular or fixed pelvic mass is present, or evidence of metastases
The patient is premenopausal, with a very elevated CA-125, ascites, or evidence of metastases
Staging for ovarian epithelial cancer is surgical and if malignancy is suspected or expected,
Peritoneal cytology should be obtained on entry into the abdomen
The adnexal mass should be removed intact
Liver, spleen, both diaphragms, and all peritoneal surfaces should be inspected and palpated
Traditional staging includes omentectomy, pelvic and para-aortic lymphadenectomy, peritoneal biopsies, removal of uterus and adnexa and all tumor nodules
The uterus and uninvolved ovary can be left in place if the malignancy is confined to one ovary and fertility is desired
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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