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Ovarian Cancer:

Prevention and Screening

By John Coppes, M.D., Obstetrics/Gynecology, Austin Medical Center — Mayo Health System

Editor’s Note: Ovarian cancer is the deadliest gynecologic cancer, affecting one in 71 U.S. women. There is no routine screening test for the cancer, and a recent study published in the American Journal of Nursing has found that four out of f ive women over 40 have never even discussed ovarian cancer with their doc- tors. John Coppes, M.D., submitted this col- umn about the quiet signs and symptoms of ovarian cancer, empowering women to become their own advocates.

KILLER” because the disease usually spreads (metastasizes) to other areas of the body before a diagnosis is made. subsequently, treatment often starts later when the cancer may not be curable. Ovarian cancer is not different from other cancers in that the earlier the diagnosis is made, the better the chances for a success- ful outcome. in an effort to detect ovarian cancer at

an early stage, recent research has shown that there are symptoms that appear early in the development of ovarian cancer which can lead to the early diagnosis. these symptoms are often nonspecific and may be part of other conditions as well. the areas where symptoms occur include the gastrointestinal tract and the bladder. research has shown that women with ovarian cancer are more likely to have symptoms of abdominal pressure, fullness, swelling or bloating. While these symptoms may come and go in gastrointestinal disor- ders or with menstrual cycles, persistence and worsening of symptoms are the key. there is usually no fluctuation in the symp- toms with ovarian cancer. this research has also shown that there may be increased urinary frequency or pelvic pain or pres- sure in early disease. additional signs and symptoms that

women with ovarian cancer may experience:


• persistent indigestion, gas or nausea • changes in bladder habits • loss of appetite or quickly feeling full • increased abdominal girth • pain during intercourse • persistent lack of energy • low back pain • unexplained changes in bowel habits • changes in menstruation it is important to evaluate these symp- toms when they are of recent onset or coexist with other symptoms. if the symp- toms are persistent rather than fluctuating, occur almost daily or are more severe than expected, it is important that you see your physician right away. because of the nature of ovarian cancer,

there is an interest in determining if routine screening would help in the early diagnosis. major studies are underway to determine if screening large numbers of women would be beneficial. but, at this time no screening test performs well enough to recommend routine screening. there is a definite benefit from evaluat-

ing women who have an affected family member or who have a family history sug- gestive of hereditary disease. Women who have a high-risk family history of breast cancer and ovarian cancer should seek genetic counseling for potential screening for the brca-1 or brca-2 gene mutation. Women who have a first order relative (mother, sister) with ovarian cancer are said to have a family history, but routine screening is not yet indicated. prevention of ovarian cancer is probably best thought of as recognition of the fac- tors that increase the risk of cancer and those that seem to be protective. the mechanism of increased or decreased risk is not understood at this time. infertility is a major factor increasing the risk of ovarian cancer; therefore, having a number of chil- dren is protective. recent studies have indicated that post- menopausal use of hormone replacement therapy may increase the risk of ovarian

cancer. however, the use of oral contra- ceptives decreases the risk of ovarian can- cer. breast-feeding is also protective against ovarian cancer. diet and exercise are not related to this disease, but women who are obese have a higher risk of disease. it is important that you see your doctor

if you are concerned about symptoms that suggest ovarian cancer. a trip to the doctor can be stressful and it is important to be ready for the visit. consider preparing for the visit by following the steps below: • Write down any symptoms you are

having. • Write down any personal information. • make a list of all your medications as

well as vitamins and herbal supplements. • have a family member or friend join

you. • Write down the questions you have

for the doctor. the fear of cancer can be paralyzing. if

you are concerned, it is important that you do not ignore your concerns, but rather, visit your health care provider promptly. for more information on ovarian cancer,

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