The good news is that ovarian cancer is relatively uncommon, striking one in 70 women during their lifetimes. But the bad news is that it is still hard to detect at an early stage.

Early detection of ovarian cancer--while it is still confined within the ovary--results in a good chance for cure. The five-year survival rate after early detection is as high as 90%. But there are usually no symptoms of ovarian cancer at an early stage; therefore, it is often diagnosed at a more advanced, and less treatable, stage. On average, the five-year survival rate after diagnosis of ovarian cancer is about 40%, but diminishes if the cancer is advanced when diagnosed.

The following symptoms may be signs of ovarian cancer, but they may also indicate other conditions. Only your physician can help sort this out:

• Cramping, discomfort, distension, or pain felt in the abdomen or pelvis.
• Diarrhea or constipation.
• A sense of incomplete emptying of the bowel and/or bladder.
• Fluid build-up in the abdominal cavity (ascites).

Since physical examination will not necessarily detect cancer, a pelvic ultrasound, CT scan, or MRI may be ordered. If cancer is suspected, a laparoscopic examination (a nonsurgical procedure to view inside the abdomen) may be recommended, or exploratory surgery to inspect the ovaries might be performed. This surgery also enables the physician to remove visible tumors and collect fluid for analysis.

If cancer is found, the uterus, ovaries, and fallopian tubes are removed, as is cancerous tissue growing on nearby structures (such as the bowel) and adjacent lymph nodes. Chemotherapy is then given--usually six courses of intravenous platinum and paclitaxel. During this period, levels of a protein called CA125 are measured to judge how well the treatment is working. Irradiation of the abdomen and/or pelvis may also be recommended, but this is less common than chemotherapy.

Having a mother, sister, or daughter with ovarian cancer raises a woman's lifetime risk of developing the disease from about 1.5% to 9.4%; women who carry a particular gene called BRCA2 have a lifetime risk of about 20%. Only a genetic test can determine if you have this trait. If you are indeed at high risk for ovarian cancer, you may elect to have your ovaries removed before any signs of cancer develop, or you might qualify to participate in trial therapies. Your physician can discuss these options with you.

SOURCE: Harvard Women's Health Watch, October 1998.