ANNOUNCER: Most women can remember the day they made the transition from childhood to womanhood. It was the time in their lives they first became acquainted with their ovaries.
CAROLYN RUNOWICZ, MD: The ovaries are small, usually almond-shaped organs, and they're part of the reproductive organs, which include the fallopian tubes, the uterus, the cervix, the vagina.
The ovaries make hormones, estrogen plus progesterone, and this starts at puberty, when a girl goes developing breasts, getting a period. Pregnancy is related to the hormones that are coming out of the ovaries as well as the egg that comes out of the ovaries.
ANNOUNCER: Despite women's familiarity with their ovaries' activity, ovarian cancer often goes unnoticed because it doesn't have obvious symptoms until it is in its advanced stages. Or does it?
CAROLYN RUNOWICZ, MD: Actually, I think we are now getting away from the concept of ovarian cancer as a silent killer. The current concept that has evolved with the patients who have survived ovarian cancer and have become a very vocal advocacy group have made it very clear that there are symptoms. The problem is that the symptoms don't point with a big red flag to the ovaries.
ANNOUNCER: Research is lending strong support to the notion that ovarian cancer is often preceded by a persistent cluster of vague, but recognizable, symptoms.
CAROLYN RUNOWICZ, MD: The symptoms can be very, very nonspecific. The back pain, lower abdominal pain, bloating, indigestion and so most of these symptoms in patients and in a doctor's eyes would point to the intestinal system. You would think you had reflux or GERD or constipation, and so it's a confusing picture. And so we don't have any specific symptoms to say to patients, "If you develop this, then you need to immediately be seen, because that's a symptom of early stage." So, unfortunately, most of the patients are diagnosed with advanced stage.
ANNOUNCER: The best case scenario would be the development of a screening test that detects ovarian cancer at an early, more curable, stage.
Some women may have heard of the CA125 blood test and transvaginal ultrasound, but doctors say that these tests are not reliable ways to detect ovarian cancer in most women.
CAROLYN RUNOWICZ, MD: There is no screening test for the average population, and I think that's very important. If every woman went out and got a CA125, we could basically diagnose ovarian cancer. However, 20 percent of tumors do not make CA125, so you'd pick up 80 percent, which would be okay. But, the problem is the CA125 is secreted by many organs and is an index of inflammation.
ANNOUNCER: So currently these screening tests are reserved for women who are at particularly high risk.
CAROLYN RUNOWICZ, MD: We do use it for screening in certain circumstances. For example, if you had a BRCA mutation (a BRCA mutation is a mutation in a gene that puts you at risk for breast and ovary cancer), we would recommend that you get CA125. If you've had ovarian cancer, we would recommend it. But, other than that, we don't use it for screening.
ANNOUNCER: But since most women don't have a worrisome ovarian cancer gene mutation, what should women do?
CAROLYN RUNOWICZ, MD: Well, I think your yearly examination with your gynecologist is probably the best thing that one can do. And, if one has symptoms that are persistent of indigestion, bloating, change in bowel habits one should see a physician, including a gynecologist.
ANNOUNCER: If your healthcare provider suspects ovarian cancer, prompt action can be taken. Surgery would be likely to confirm a diagnosis.
CAROLYN RUNOWICZ, MD: Let's say you had symptoms or, on routine pelvic examination, your doctor detected a mass, you got a sonogram and the sonogram confirmed that there was a mass there and that there might be some characteristics that were suggestive of malignancy. One would get a CA125. Now, that is not a screen, that a little difference because there's a mass there. So something is prompting you to further investigate.
So all of that sort of comes together in the physician's mind, as sort of like a puzzle. You have an index of suspicion based on the CA125, the characteristics of the tumor, your pelvic exam, the age of the patient, the family history of the patient, the personal history of the patient. You put all those factors together and you then kind of come up with, "Well, I think this is going to be benign," or "I think this is going to be malignant." And, if you think it's going to be malignant, then the patient should be referred to a gynecologic oncologist.
ANNOUNCER: Because ovarian cancer is not very common, and most women who have these symptoms will not have ovarian cancer, women and their healthcare providers must team up to carefully analyze symptoms. Together.
CAROLYN RUNOWICZ, MD: What I think patients really need to do is empower themselves and, if they have persistent symptoms, persistent indigestion, persistent constipation, persistent change in bowel habits, persistent bloating, they should see their gynecologist and they should get a pelvic exam.