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Co-Editor-in-Chief, Tracy E. Austin, MD Tuesday, January 5, 2010 - 07:01 PM Obstetricians/Gynecologists-OB-GYNs-New York:

A Silent Killer of Women

Cancer is defined as a disease process in which cells grow unregulated by the body part it is inhibiting. Cancer can remain confined to that part of the body, where it starts, or it can spread (a process called metastasizing.)

Among American women, ovarian cancer is the fifth most common cancer. Of the cancers that attack the female reproductive system, it is the leading cause of death. About two-thirds of the deaths from ovarian cancer occur in women age 55 and older. A quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.


The cause of ovarian cancer is unknown, as the risk for developing it is related to many factors. The strongest risk factors are hereditary. Women with a personal history of breast cancer, a family history of breast or ovarian, and/or mutations of the BRCA1 and BRCA2 genes have an increased risk for developing ovarian cancer.

Childbirth as Protection

Women, who conceive their first child at an early maternal age, have a reduced risk of developing ovarian cancer. The same goes for women that have multiple births earlier in life

with the final pregnancy at an older age. Women using low dose hormonal contraception have also been shown to have a protective effect where ovarian cancer is concerned. In fact, women who used oral contraceptives for 10 years had about a 60% reduction in risk of ovarian cancer.


The symptoms of ovarian cancer are notoriously nonspecific. They are viewed as any of the conditions that affect the abdominal, gastrointestinal, and pelvic regions. The nature of these symptoms often causes ovarian cancer to be misdiagnosed because a physician may conclude that another condition is to blame for your symptoms. This appears to be the rule, rather than the exception. Unfortunately, by the time the cancer is diagnosed, the tumor has often spread beyond the ovaries to more vital organs. Thus, ovarian cancer is called a “silent killer.”

Some symptoms of ovarian cancer are: •bloating, and/or vague lower abdominal discomfort, •increased abdominal girth, •difficulty ingestion normal meals, and/or feeling full quickly, •abnormal menstrual cycles, •pelvic or abdominal pain, •and urinary symptoms (urgency or frequency).


Physicians can run a myriad of tests, to aid in the diagnosis of ovarian cancer. Some of the less invasive tests used are: •a complete blood count (CBC), •blood chemistry, •CA125 (blood test), •quantitative serum HCG (commonly known as a blood pregnancy test), •alpha fetoprotein, •abdominal x-rays/imaging, •trans-vaginal ultrasound, or abdominal CT scan.

It is important to note that, although these tests could help render a diagnosis, none of the above tests are part of routine screening for any gynecologic cancer condition.

Ultimately, the definitive diagnosis of ovarian cancer will come from biopsy, which is a surgical procedure aimed at taking specimens from the abdomen for analysis.

Ovarian Cancer Screening

As you’ve probably gathered from my personal story, the pap smear does not detect this cancer. In fact, the pap smear is a screening test for cervical cancer, not ovarian cancer.

What is a screening test? They are used to detect disease in individuals without signs or symptoms of that disease. The intention of screening is to identify disease early, thus enabling earlier intervention, treatment, and possible cure.

In truth, there are no definitive screening tests or guidelines for ovarian cancer. However, ovarian cancer is highly fatal (about 45% live longer than 5 years after metastatic disease). It is also rarely diagnosed in its early stages. Because of these factors, there has been an increasing amount of research and debate over whether the medical community’s implementation of screening is for ovarian cancer.

The screenings are already in place for other gynecologic malignancies such as cervical and breast cancer, via pap smears and mammograms respectively. In fact, if diagnosis is made early in the disease, and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate of ovarian cancer is about 94%.

Be Vigilant and Proactive

Until there is definite screening for ovarian cancer, it is important that all women take a proactive position in terms of personal health. Call for an appointment with your provider if you have any of the symptoms of ovarian cancer, or if you are a woman over 40 years old with any of the above symptoms, and have not recently undergone a pelvic examination. Women age 21 and above, should have routine pelvic examinations annually. Ultimately, ovarian cancer detection highly relies on a woman’s personal vigilance and her awareness of her own body.

It is possible to beat these odds on your own, by being proactive. Women experiencing any of the aforementioned symptoms should see their gynecologist or request a referral from to one from the family doctor. This will improve your chances of early diagnosis, which will also lead to a brighter prognosis. For referenced resourced information, go to

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