A complete clinical assessment should be done on the patients suspected to have ovarian cancer. The first set of imaging tests should be an ultrasound of the abdominal and pelvic regions. A CT scan also helps in understanding the extent of the disease in order to plan better for the surgery. In order to spot pleural effusion; a chest X-ray helps. In patients who are suspected of ovarian cancer; CA-125 which is the tumor marker is routinely checked. Patients suspected of intestinal symptoms; an upper and lower body endoscopy should be performed.
Why is it important to screen for ovarian cancer?
In the United States, ovarian cancer is the primary cause of death among gynaecological malignancies. Early ovarian cancers frequently have no obvious signs and symptoms. When it comes to ovarian cancer, the majority of symptoms don't appear until the disease has advanced to an advanced stage.
Basis of Screening:
Survival rates for ovarian cancer
The percentage of people of the same age and stage of cancer who survive after initial diagnosis is defined as the survival rate. Ovarian cancer survival rates help if the treatments will be effective on the patient or not.
The percentage of people who live for five years after diagnosis is called the five-year survival rate. The overall five-year survival rate of ovarian cancer patients is 46% with the general prognosis continuing to be weak. Depending on the stage of the disease; the outcome for patients depends.
Survival rates for the different types of ovarian cancer
Epithelial ovarian cancer
Ovarian stromal tumors
Ovarian germ cell tumors.
Fallopian tube carcinoma
What are the different screening systems available for ovarian cancer?
Early diagnosis and screening of ovarian cancer increases the chances of successful treatment and recovery. Depending upon the various factors such as type of cancer, age, medical history, and the results of earlier medical tests; doctors decide the type of screening mechanisms best for the patient.
The different types of screening tests/ processes are as follows:
Abdominal pelvic exam
Physical exams based on the medical history and symptoms of the patient are conducted. During these tests; doctors look for signs like an enlarged ovary and fluid in the abdomen. Examination of the uterus, vagina, ovaries, bladder, and rectum is also done for unusual changes.
Transvaginal Ultrasound (TVS)
TVS is a device that examines the ovary, fallopian tubes, and uterus using sound waves by inserting an ultrasound wand into the vagina. This type of test is used to identify a mass or tumor in the ovary. But, it cannot determine whether the mass cells are cancerous or benign. Studies showcase that most mass cells determined using this type of testing are not malignant.
The blood tests for ovarian cancer include:
- Routine blood investigations (CBC, LFT, RFT, Serum Electrolytes)
- Test for tumor markers (CA-125, AFP, LDH, beta HCG, etc.)
CA-125 blood test
It is a blood test that measures the levels of the protein CA-125 in the blood. CA-125 increases in 50% of patients with early ovarian cancer and 80% of patients with advanced disease. High levels of CA-125 are seen in women with ovarian cancer.
Disadvantage: Its specificity is inadequate. It is escalated in conditions other than ovarian cancer majorly endometriosis, uterine leiomyosarcoma, pelvic inflammatory disease, cancers of the breast, endometrium, lung, and pancreas.
It is a surgical procedure which involves removal of a small amount of tissue that is taken to the pathologists for examination under a microscope to see if it is cancerous or not. Biopsy is the standard gold test for cancer diagnosis.
The imaging studies include:
- Chest X-rays
- Ultrasound abdomen.
- CT or CAT (computed axial tomography) scans of the whole abdomen and chest
- PET (positron emission tomography) CT scans of the entire body.
- Transvaginal ultrasound.
Computed tomography (CT) scan
A three-dimensional picture of the inside of the body is created using X-rays from different angles. The dye is used to enhance the images and differentiate tumors from healthy tissues. The color is either injected into the veins of the patients or given as a liquid to swallow or both.
Positron emission tomography (PET) scan
PET can help determine the distant spread of the tumor. Patient’s body is injected with a small amount of radioactive substance (sugar). Due to the nature of tumor cells; those cells that take up energy from these substances are termed as tumor cells. A scanner is used to detect this substance and produce images of the inside of the body.
Risk of ovarian cancer algorithm (ROCA)
It is a statistical tool used to check the risk of developing ovarian cancers depending on a woman’s age and changes in the levels of the protein CA-125 over some time. This test is also sensitive enough to rule out the possibility of ovarian cancer at its earliest stages (Stages 1 and 2).
Screening tests for germ cell tumors and stromal tumors
Human chorionic gonadotropin (HCG) and alpha-fetoprotein are common protein markers seen in germ cell tumors that are identified with the help of a simple blood test. After the detection; surgery or chemotherapy are usually recommended.