Click here for YNHH home page.


Sign up for HealthLINK.

Can we help?

Follow up on this month's He@lthLINK

 

He@lthLINKs

Site Contents


Phone Numbers

Directory assistance
(203) 688-4242

Patient information
(203) 688-4177

Adult emergency
(203) 688-2222

Children's emergency
(203) 688-3333

Admitting
(203) 688-2221

Children's admitting
(203) 688-3331

Psychiatric admitting
(203) 688-9907



Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202




Site Contents


 Yale-New Haven Hospital, New Haven, Connecticut, USA HealthLINK: Cancer

May 17, 2000

News this month
Ovarian cancer: A cancer that whispers

Ovarian cancer has been called the cancer that whispers because it often has no clear cut symptoms until the cancer has progressed to a more advanced stage. Adding to the problem is the lack of screening tools that are easy to use and highly reliable. For example, the tumor marker blood test most widely used for ovarian cancer, CA125, is not always accurate, leaving physicians and researchers to search for a better way to detect the cancer that claims the lives of more than 14,000 women each year.

Ovarian cancer claims the lives of more than 14,000 women each year.

Research underway
This search is leading to the development of new tumor markers that can detect the presence of small amounts of cancer cells before other tests can. Traditional diagnostic procedures, such as ultrasound, are also being used to detect the cancer earlier, increasing survival. These efforts have been formally organized by the National Cancer Institute, which has sponsored two trials that address ovarian cancer screening. The first, the National PLCO, which stands for Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, is a 16-year-long, large-scale, randomized study that will test many screening tools, including whether CA 125 and transvaginal ultrasound can reduce ovarian-cancer mortality in women aged 55-74.

The second trial, the National Ovarian Cancer Early Detection Program: Screening and Genetic Study, will:

  • identify women at increased risk for ovarian cancer;
  • develop new and highly sensitive tumor markers for ovarian cancer;
  • determine whether office laparoscopy and the ovarian "pap" test are useful screening tools and whether molecular technologies can augment this test;
  • develop new therapies for ovarian cancer.

Gains in ultrasound
Significant progress is being made using ultrasound to view the ovaries and any abnormalities. This February, a group of oncologists from the University of Kentucky presented their findings on using ultrasound to detect ovarian cancer at the 31st Annual Meeting of the Society of Gynecologic Oncologists in San Diego. The researchers used transvaginal ultrasound (TVS) to screen 14,000 asymptomatic women for ovarian cancer. Of the 180 patients with persistent TVS abnormalities that underwent exploratory surgery, 17 ovarian cancers were detected, of which 14 were stage I or II (early-stage) at diagnosis.

Significant progress is being made using ultrasound to view the ovaries and any abnormalities.

With a mean follow-up of 4.6 years, all of the patients with early-stage disease were still alive without recurrence, while two of the three patients with advanced stage disease died. Of the group without initial evidence of abnormality, four patients developed ovarian or primary peritoneal cancers within one year of a negative scan. Of these, two had early stage disease and two were advanced stage.

After a total of 46,113 screening years, there were three ovarian cancer deaths in the annually screened population and a five-year survival of 88 percent for the ovarian cancer patients in the study population. This was considerably better than survival rates of only 30 to 40 percent for all ovarian cancer patients. Because the overall incidence of ovarian cancer detected was only 9 percent and because of the expense and inconvenience involved, using TVS to screen all women may not be practical on a large scale.

The search for tumor markers
A method that could see wider use is the development of new tumor marker tests that are more accurate than the CA125. One substance called LPA, short for lysophosphatitic acid, has been shown to stimulate the proliferation of ovarian cancer cells and has also been found in the fluids of ovarian cancer patients. (Build-up of abdominal fluid is common in this disease). Could high amounts of the substance in blood signal the presence of ovarian cancer?

LPA [has been suggested] as a potential biomarker for ovarian cancer.

LPA v. CA125
In 1998, researchers at the Cleveland Clinic were among those suggesting LPA as a potential biomarker for ovarian cancer. They published their findings in the Journal of the American Medical Association, comparing the accuracy of LPA with CA125 in detecting ovarian cancer. In the study, LPA levels from 48 healthy control women, 48 women with ovarian cancer, 36 women with other gynecologic cancers, 17 women with benign gynecologic diseases, 11 women with breast cancer and 5 women with leukemias were tested for levels of LPA and CA125. Elevated plasma LPA levels were detected in:

  • nine of 10 patients with stage I ovarian cancer;
  • 24 of 24 patients with stage II, III, and IV ovarian cancer;
  • and 14 of 14 patients with recurrent ovarian cancer.

Women in the ovarian cancer groups had significantly higher plasma LPA levels than women in the healthy control group. LPA was also useful in detecting 33 of 36 other types of gynecologic cancers. The researchers stressed that these data, however encouraging, were preliminary and ongoing studies will determine the future use of LPA in detecting ovarian cancer.


Physician Referral Online

A free and confidential service
of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

Request an appointment
We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.
Peter Schwartz, MD

Ovarian cancer: Improving the odds for today and tomorrow

In the last few years, we physicians have witnessed tremendous growth in what is known about ovarian cancer, but there is so much more to know. All of these studies are welcome additions that help in our ability to treat this disease. Sadly, there remains a lack of overall knowledge about ovarian cancer. When I speak to community groups about ovarian cancer, there is not the widespread knowledge about ovarian cancer that you find with breast or other types of cancer. And that’s a dangerous thing because ovarian cancer is the fifth leading cause of cancer death among women in the United States.

"My personal goal is to increase awareness so more women can come into our Ovarian Cancer Detection Program at Yale with earlier, more treatable cancers."

This year, about 23,000 women will be diagnosed with ovarian cancer. Women who are diagnosed with early cancer have a very good prognosis for survival. Women with localized disease (that has not spread) are three times more likely to survive five years than women with cancer that has spread. However, only a quarter of women are diagnosed with early stage ovarian cancer. My personal goal is to increase awareness so more women can come into our Ovarian Cancer Detection Program at Yale with earlier, more treatable cancers.

Subtle signs
There are no obvious early warning signals with ovarian cancer. Rather, early on, this disease has no symptoms or very subtle signs. Signs to look for might include a change in bowel habits, such as gas, indigestion or swelling, sometimes nausea or feeling full, increased urination or unexplained weight gain or loss. What should raise a red flag for women is the persistence of these symptoms. Conditions other than cancer can cause these symptoms. Your first step must be to talk to your doctor. If he or she does not take your symptoms seriously, then it may be time to switch doctors.

Risks for ovarian cancer include being Caucasian and having a mother, sister or daughter with ovarian cancer.

Who’s at risk?
It’s also helpful to know who is at higher risk of developing ovarian cancer. In Connecticut, we have the oldest tumor registry in the country. A comparison of data from the state’s seven largest hospitals in the 1970s yielded the first clues about these risks, including being Caucasian and having a first-degree relative with ovarian cancer. A first-degree relative is a mother, sister or daughter. In our study, the risks for ovarian cancer if you had a first-degree relative with the disease were 18 fold over the control population. Additional studies have since shown the actual risk to be smaller—three and one-half times the control risk—but still very significant for women with first-degree relatives.

And of course age is a significant factor. The average age at diagnosis is 63. But that should not lull younger women into a false sense of security if they are having symptoms. Having had breast cancer doubles the risk of developing ovarian cancer. Fertility drugs may also increase the risk, although the evidence is not clear. Evidence has been inconclusive about the link between ovarian cancer and talcum powder use for personal hygiene.

Protective events
Events in a woman’s life that inhibit the release of eggs from the ovaries appear protective against developing ovarian cancer. These include having many children, breastfeeding and taking oral contraceptives. In Connecticut, a woman who has never had children has a risk five times greater than that of a woman who had five or more children.

"There are definite problems in using [CA125] to diagnose ovarian cancer…"

Using CA125
In the past, CA125 has been the best method available to monitor women with ovarian cancer for recurrence. But there are definite problems in using it to diagnose ovarian cancer in women, particularly in those who have not undergone menopause. Any irritation to or inflammation of the lining of the abdominal cavity (the peritoneum) can increase the CA125 reading. Endometriosis can elevate levels of CA125 as can fibroid tumors of the uterus, or the combination of the two. A woman should never have a CA125 test during her period, as menses are associated with elevation of CA125.

Looking to ultrasound
As this latest presentation by the Kentucky researchers points out, ultrasound makes sense for diagnosing this type of cancer. This is particularly true for younger women who have a higher occurrence of noncancerous cysts, which can cause symptoms similar to those of ovarian cancer. About 15 percent of premenopausal women have "simple" cysts at one time or another, which we follow, but which tend to go away on their own. These are distinguished from "complex" cysts, which look like lumps on the inside of a balloon and require further investigation.

Future directions
We should be able to make a real impact in the fight against ovarian cancer in the near future by:

  • educating women and physicians about ovarian cancer;
  • identifying and following women at increased risk of ovarian cancer;
  • developing new and more specific tools to aid in that diagnosis, and;
  • coming up with better treatments for ovarian cancer.

In the meantime, it is critically important to detect and treat this disease as early as possible.

Dr. Schwartz is a gynecological oncologist affiliated with Yale-New Haven Hospital and director of the Yale High Risk Ovarian Cancer Clinic.


Spacer.
Subscribe to HealthLink.

 

Other related links.

Copyright 1999-2008.
Top of Page. Y-NHH. YNHHS. Site Editor.

Home page
Staff directory
Directions and parking
Online resources
Yale New Haven Health System		   Need a doctor?
Search
Comments
Top of page
Yale-New Haven Medical Center

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.