University of Virginia Health System

Ovarian Cancer Diagnosed by Symptoms plus Blood Test

Researchers boosted the level of early-stage ovarian cancer detection by 20 percent through use of a blood test to detect a tumor marker as well as a woman's report of new-onset symptoms.

Using the two techniques together found 80 percent of early-stage tumors, according to a report in the journal Cancer.

"They appear to act complementary, and appear to be able to identify women who would not be identified by a blood sample alone, and conversely would not be identified by symptoms alone," says the study's lead author, M. Robyn Andersen, Ph.D., of the Fred Hutchinson Cancer Research Center.

More than 21,000 women are diagnosed as having ovarian cancer annually, and more than 15,000 women die from the disease each year, according to the American Cancer Society (ACS).

Only about 20 percent of ovarian cancers are now caught in their earliest, potentially curable stages, Andersen says.

Susan Modesitt, M.D., a gynecologic oncologist and Associate Professor of Obstetrics and Gynecology at the University of Virginia Health System, says the study's results are unsurprising.

"Women with ovarian cancer often have symptoms that predate their diagnosis for six to 12 months that are not recognized as symptoms of ovarian cancer," Modesitt says.

Abdominal Pain, Bloating and Feeling Full

In 2006, Dr. Barbara Goff of the University of Washington published the ovarian cancer symptom-screening index tool in an effort to help women and physicians clarify which women might have a heightened risk of ovarian cancer.

Important symptoms include pelvic or abdominal pain, bloating, increased abdominal size, difficulty eating or feeling full quickly.

These symptoms must occur more than 12 times per month, and have just recently begun occurring (within the past year), to be considered positive on the symptom-screening tool.

For example, if a woman has had abdominal pain for the past 10 years, it is probably not related to ovarian cancer but to another disorder, such as irritable bowel syndrome.

For the current study, Andersen and her colleagues used the symptom-screening index and a blood test that looks for CA-125, a protein that is often elevated in ovarian cancer. However, CA-125 can sometimes be elevated in women who do not have ovarian cancer, the researchers noted.

The study involved 254 healthy women at high risk for ovarian cancer because of family history, as well as 75 women about to undergo ovarian cancer surgery. The women were asked to fill out a questionnaire about their symptoms. All of the women also gave a blood sample to have their levels of CA-125 measured.

The two methods together correctly identified almost 90 percent of the ovarian cancers - 80.6 percent of the early-stage cancers and 95.1 percent of the later-stage cancers.

About 14 percent of women who had symptoms and had elevated levels of CA-125 did not have ovarian cancer, according to Andersen. These women received transvaginal ultrasound tests for follow-up, she says.

Diagnosing Still an Inexact Science

"This study continues to add on to the work that's been done, but we still have a long way to go with ovarian cancer," says Debbie Saslow, Ph.D., Director of Breast and Gynecologic Cancer for the American Cancer Society (ACS). "None of the current screening tools is as accurate as the ACS and other experts would like them to be."

Any of the tests alone misses a significant number of cancers and unnecessarily worries women who do not have cancer.

Saslow says transvaginal ultrasound can be a good test, but it has to be done by an experienced sonographer, and there are no guidelines to define how much experience is sufficient.

Saslow also notes that no research has been done to prove that early detection saves lives.

Andersen says the researchers recommend that if you have any of the symptoms of ovarian cancer, and they are new-onset symptoms, that you should discuss them with your physician.

But, she adds, "Even with this specific pattern of symptoms, most women probably don't have ovarian cancer, just as most women with a breast lump don't have breast cancer."

UVA's Modesitt says people need to be alert for symptoms of ovarian cancer, including feeling full early during meals, bloating and abdominal pain. The standard practice for women complaining of these symptoms, Modesitt says, includes a full physical examination (including a pelvic exam), a CA-125 test and transvaginal ultrasound.

About 10 percent of ovarian cancer is hereditary, Modesitt notes, so women with a family history of ovarian cancer or premenopausal breast cancer should consider seeing a specialist to see if they would benefit from steps such as increased screenings or risk-reduction measures.

UVA also offers a free, confidential risk assesment through the region's only High Risk Care program to determine if you have a higher-than-normal personal risk of developing breast or ovarian cancer. This free service is particularly encouraged for women with a strong family history of breast or ovarian cancer. To arrange the free screening, call 434-982-0808.

For more information about ovarian cancer or other women's health topics, visit www.uvahealth.com. 

Always consult your physician for more information.