Ovarian Cancer: The Silent Killer

Known as the “silent killer,” ovarian cancer can sneak up on a woman with vague symptoms that mimic other common benign conditions.

Abdominal or pelvic discomfort, urinary urgency, constipation, and pelvic fullness are common. But these same symptoms can occur from something as innocuous as a urinary tract infection or as common as diverticulitis. However, in the case of ovarian cancer, the symptoms worsen and progress to abdominal bloating and the inability to eat. At this point, most women realize something is wrong, but unfortunately, the cancer is likely to be advanced already.

To make matters scarier, currently there is no screening test for ovarian cancer. Many women are confused by inaccurate recommendations they might read in women’s magazines. I have seen articles suggesting that all women should demand from their doctor a CA-125 blood test to “check for ovarian cancer.” Unfortunately, the CA-125 test is not accurate in the capacity of a screening test. For that to be the case, a CA-125 value, if checked on a normal healthy woman, would be able to distinguish between a woman who does or does not have ovarian cancer. However, about one-third of women with ovarian cancer have a normal CA-125. In addition, as we’ve discussed, many other conditions make the CA-125 abnormal, such as appendicitis, endometriosis, fibroids, cirrhosis of the liver, pelvic inflammation, recent surgery, ectopic pregnancy, etc. Since the test can’t distinguish between cancer and non-cancer, it is not useful to screen all women. However, it is used as a marker to track the progress of treatment in a woman with known ovarian cancer. Along the same lines, when a woman with a mass has a normal CA-125, it doesn’t mean she doesn’t have cancer. Only by surgically removing the mass can we be sure. Sometimes ovarian cancer cannot be diagnosed until the time of surgery. But, in many cases, all the signs point to it.

Ovarian cancer affects about 1 in 70 women over their lifetime. To put this in perspective, about 1 in 8 women will get breast cancer. But, although ovarian cancer is uncommon, it is devastating when it does occur. Treatment typically involves both surgery and chemo- therapy. Surgery for early ovarian cancer has two goals: diagnose the cancer and identify its stage. For advanced cases, the goals shift: diagnose the cancer and remove all involved areas that can safely be extracted. Like uterine cancers, ovarian cancers are staged based on the findings at the time of surgery, so the cancer stage cannot be known until comprehensive surgical staging/debulking (removal of the tumor) is performed.

Standard surgical staging procedures for ovarian cancer include hysterectomy with bilateral salpingo-oophorectomy (BSO: both ova- ries and tubes), an omentectomy, removal of pelvic and abdominal lymph nodes, and biopsies of the abdominal cavity. The omentum is a large fatty internal apron of tissue that drapes off the colon and stomach.

Ovarian cancers commonly spread to this organ, and it should be removed in all ovarian cancer surgery. Debulking surgery for more advanced disease also includes hysterectomy/BSO, but often much more than that. Omentectomy, removal of diseased areas on the in- testines, colon, diaphragm, liver, or spleen may also be necessary. In debulking surgery, essentially any area that is involved needs to be removed if surgically feasible. The goal of ovarian cancer debulking surgery is to complete the operation with the minimum of visible cancer remaining because chemotherapy is always necessary after surgery for advanced ovarian cancer, and the treatments are most effective when beginning with the smallest number of cancer cells left behind to treat.