Cancer of the Ovary

Posted by John Marlow, M.D. - 30/03/09 at 04:03:33 pm

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Screening tests for cancer of the ovary remains a challenge for today’s medicine. Ovarian cancer is the most lethal of all gynecologic malignancies and was responsible for over 15,000 deaths in 2008. Tragically, seventy percent of these women were in the advanced stage when diagnosed.
There has been little improvement in the past several decades to reduce this statistic. Cervical cancer, in contrast, has had a dramatic reduction in death rate. The combination of improved cytology, HPV testing, colposcopy and recently a vaccine for the high-risk papilloma virus have combined to achieve this result.

The Obstetrics and Gynecologic Journal for 2009 highlighted the current state of tests available for detecting early cancer of the ovary, specifically the combination of a blood test, Ca 125, and transvaginal ultrasound. Dr. David Mutch of Washington School of Medicine reviewed a large prospective multiinstitutional study concerning ovarian cancer screening. The original research article followed his editorial.

Of the 39,115 patients in the 4 year study assigned to the screening arm of the study, greater than 70% of the patients were in the advanced stage of cancer when diagnosed. Dr. Mutch noted that based on these data, screening the general population for ovarian cancer with the combination of these two tests will not be beneficial.

The problems in developing a screening test for ovarian cancer are numerous. This cancer has a low incidence: 1 in 2500 women in the postmenopausal population. Another problem is the that the ovary, unlike the cervix, is not easily accessible. It is deep in the protective pelvic ring so that early changes may not be easily felt. Laparoscopy gives us access to the ovary but requires a surgical procedure. The Green Journal study above found the ration of surgery to detected ovarian cancer to be 20 to 1. Stated another way, there are many false positive tests using Ca 125 and transvaginal ultrasound.

Breakthroughs in developing screening test for ovarian cancer continue to be an unattained goal. Ovarian cancer is an understandably frightening prospect for all women and their families. It is hidden from early view and frequently fatal. Given sufficient priorities, scientifically and financially, it is an attainable and important challenge.

References:
1. Jemal A, et al Cancer Statistics 2008. CA cancer J Clin 2008; 58:71-96
2. Mutch DG: Ovarian Cancer. Obstet & Gynecol Vol 113, No 4, April 2009:772-774 3. Partridge E, et al Results From Four Rounds of Ovarian Cancer Screening in a Randomized Trial. Obstet & Gynecol Vol 113, No 4, April 2009: 775-782