Detection and Prevention in Ovarian Cancer

It is Ovarian Cancer Awareness Month and today we are looking at the topic of detection and prevention.

Ovarian cancer is one of the most common types of cancer in women. There are around 7,400 new ovarian cancer cases in the UK every year, which results in 20 new cases a day. It is the 6th most common cause of cancer death in females, with around 4,200 deaths in 2018 in the UK.

Given the prevalence of ovarian cancer among women, and given that it is often a deadly disease, early detection and treatment is critical.

Detection

There are two tests that are most often used to screen for ovarian cancer. These are:

Transvaginal ultrasound scan (TVUS); and
CA-125 blood test.

Blood test (CA125 test): If after a consultation with your GP they believe your symptoms could be ovarian cancer they may refer you for a blood test to check for a substance called CA125. CA125 is produced by some ovarian cancer cells. A high level of CA125 in your blood could be a potential sign of ovarian cancer.

But a raised CA125 level does not mean you definitely have cancer, as it can also be caused by other conditions such as endometriosis, fibroids or pregnancy.

Ultrasound scan: There are two types of ultrasounds that are used to detect ovarian cancer. One type of ultrasound uses a small device called an ultrasound probe to move over your stomach to create an image of your ovaries. This is the abdominal ultrasound. The second ultrasound is transvaginal. An ultrasound probe is passed into the vagina to create a clearer image of the ovaries. The scan can show changes in the ovaries that could be caused by cancer. Following an ultrasound scan a CT scan may then be recommended.

While some women diagnosed with ovarian cancer have elevated levels of the CA 125 protein, the associated blood test is not accurate enough for ovarian cancer screening, as many non-cancerous conditions can increase the CA 125 level.

Calls for greater screening

Ovarian cancer is hard to detect in its early stages due to its vague symptoms.

As a result of this, there is a call for further action to help detect ovarian cancer. It is proposed that more frequent scans and blood tests should be available to patients at a younger age, in order to increase the chances of detecting ovarian cancer at the earliest possible stage.

The United Kingdom Collaborative Trial of Ovarian Cancer Screening has looked at whether screening could be useful in ovarian cancer. Screening is a way of finding out if people are at higher risk of a health problem so that treatment can be offered sooner.

So far, the screening trial has determined that there is not enough evidence to support the introduction of a national screening programme. However, they have advised that further research is ongoing to see whether screening could become a viable strategy.

Preventability

According to Cancer Research UK, 11% of ovarian cancer cases are preventable.

There are several ways a person can reduce their risk of developing ovarian cancer. Some risk factors for ovarian cancer cannot be changed, such as getting older or family history, but other risk factors can be controlled.

Oral contraceptives: Using oral contraceptives decreases the risk of developing ovarian cancer for average risk women and BRCA mutation carriers, especially among women who use them for several years.

Hormone replacement therapy (HRT): It has been suggested that taking hormone replacement therapy (HRT) may increase your risk of ovarian cancer. It’s thought that if there is any increase in cases of ovarian cancer in women taking HRT, the risk is very small. Any increased risk of ovarian cancer is thought to decrease after you stop taking HRT.

Smoking: Smoking can increase the risk of certain types of ovarian cancer. Approximately three per cent of some types of ovarian cancer seem to be linked to exposure to tobacco smoke.

In order to prevent ovarian cancer from being fatal it is important that it is detected as early as possible. Mistakes in diagnosing ovarian cancer can therefore be extremely serious.

Common mistakes that can be made are failure to carry out appropriate examinations or failure to refer a patient to a gynaecological oncologist for further investigation.