Ovarian Cancer Screening Changes

My mother-in-law passed away from complications of ovarian cancer about a decade ago. She was only 56 years of age, and she was gone within a year.

When she was diagnosed with it, she was already in stage IV. As with the most cases, diagnosis is usually found in later stages because of the symptoms being so vague or slight. Most women with ovarian cancer develop it after menopause. Also, metastasis is commonly found in many cases.

Actual cause is still unknown. However, there does seem to be some possible link in certain populations that are put at higher risk, such as women of Ashkenazi Jewish decent, or those with BRCA1 or BRCA2 mutations. If a woman has two first-degree relatives with ovarian cancer, that also increases her risk for ovarian cancer. Interestingly, non-hereditary ovarian cancer usually occurs at an earlier age.

The symptom that led my mother-in-law to go to the doctor was a “stomach bug” that lasted over two weeks. She was having diarrhea that would not clear up. She had smoked heavily for over 20 years, but stopped smoking a few years prior to her diagnosis. No one in her family had breast or ovarian cancer, but her mother did have some type of “blood cancer.” Ovarian cancer is thought to be hereditary in only about 5 to 10 percent of all cases.

I often wondered if she had any other symptoms. I don’t remember her ever being sick, and we saw her frequently. She never lost weight (she was overweight), and she never complained about being tired. I do remember her gynocologist recommended she have a hysterectomy in her 40s, but she did not have the money or health insurance at the time, therefore, she did not have it done. Unfortunately, she stopped going to her gyn for annual checkups after she completed menopause.

This week I read an article that is shedding some light on possible changes in how we screen for ovarian cancer. It involved a cohort of women from the Prostate, Lung, and Colorectal and Ovarian Cancer Screening Trial. It discussed using the tumor marker, CA 125, with transvaginal ultrasound and found that using both may lead to an earlier diagnosis for high-risk, asymptomatic women.

The normal level for the CA 125 is less than 35 units/ml. Previously, the NCCN stated that using the tumor-marker alone or with transvaginal ultrasound was not a tool for screening. However, a recent study followed 3,224 women, over a four-year period, and found two high-risk categories: those women with negative transvaginal ultrasound scans and a CA 125 level of 70 units/ml or higher; and a positive transvaginal ultrasound and high CA 125 lab level. This criterion was discovered at the “T0” staging level and had a sensitivity of 60 percent and a specificity of 96.2 percent.

There were also findings at the staging level of “T1,” which pointed to three high-risk categories that included a change in the CA 125 level or 45 units/ml or more with a negative US; a negative CA 125 level and an increase of 6cm or more in an ovarian cyst; and a positive result with the US and tumor marker. This was discovered as T1 criterion with a sensitivity of 85.3 percent and specificity of 95.6 percent.

Again, the purpose of this article was to shed light and provide more guidance to clinicians managing high-risk women for ovarian cancer. High-risk women were those who were designated with a cancer risk of 10 percent or greater. This is good news for all high-risk women. With my mother-in-law’s history, I don’t believe she would have been considered high-risk. But having annual checkups might have caught it sooner. Again, new developments equal new hope for women in the future.

Resources:

• Chemotherapy Advisor (2013). Study Provides More Data for Ovarian Cancer Risk Prediction. Retrieved from: http://www.chemotherapyadvisor.com/study-provides-more-data-for-ovarian-cancer-risk-prediction/article/274089/?DCMP=EMC-CTA_Front&spMailingID=5377386&spUserID=MTM2Nzc0NjQ3ODcS1&spJobID=62202647&spReportId=NjIyMDI2NDcS1
• Gobel, B.H., Triest-Robertson, S. & Vogel, W.H. (2009). Advanced Oncology Nursing Certification Review and Resource Manual. Oncology Nursing Society, Pittsburgh, Pennsylvania.
• Partridge, E.E., Greenlee, R.T., Riley, R.L., Commins, J., Ragard, L., Xu, J-L., Buys, S.S., Prorok, P. C. & Fouad, M.N. (2013). Assessing the Risk of Ovarian Malignancy in Asymptomatic Women with Abnormal CA 125 and Transvaginal Ultrasound Scans in the Prostate, Lung, Colorectal and Ovarian Screening Trial. Obstetrics & Gynecology. 121 (1):25-31.