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.

CLINICAL ACTIONS:

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

High Risk

  • 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

SYNOPSIS:

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.

KEY POINTS:

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
  • Diagnostic code: ICD-10: C-56.9

Learn More – Primary Sources:

ACOG and SGO Committee Opinion No. 716: The Role of the Obstetrician-Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk

ACOG Practice Bulletin No. 174: Evaluation and management of adnexal masses

Locate a genetic counselor or genetics services:

Genetic Services Locator-ACMG

Genetic Services Locator-NSGC

Genetic Services Locator-CAGC

Locate a GYN Oncology Specialist:

Gyn Oncology Locator – SGO