Ovarian Cancer. Screening
One of the most significant ways to improve survival for patients with ovarian cancer would be to find a way to screen women for ovarian cancer and detect the disease before it spreads beyond the ovary. Currently available methods for screening for ovarian cancer are pelvic examination, serum CA 125 level measurements, and pelvic or transvaginal ultrasonography. To date, there is no evidence that routine pelvic examination is effective in the early diagnosis of ovarian cancer. Serum CA 125 levels have also shown to be ineffective because of the high false-negative rates. A review of the literature found that only about 50% of patients with stage I ovarian cancer have an abnormal serum CA 125 level. To substantiate this point further, the only study to look at CA 125 screening for ovarian cancer reported that in the six cancers of the ovary diagnosed by CA 125 screening, four had spread beyond the ovary. However, in three studies, pelvic or transvaginal ultrasonography screenings of 7,576 patients diagnosed 10 cancers, all stage I. Unfortunately, this technique has a high false-positive rate, and between 13 and 65 patients underwent surgical exploration for each cancer detected in these studies. If some additional test could be discovered that would allow determination of which patient with an enlarged ovary actually needs exploration, transvaginal ultrasonography might turn out to be an effective screening tool. Current research in this area centers around developing a more precise morphology index, a more specific color flow Doppler pattern, and more specific serum markers.
TABLE 6. Stage at Diagnosis and 5-Year Survival Rate of Gynecologic Cancers, United States 2006
Stage at Diagnosis (%) 5-Year Survival Rate (%)
Site Localized Regional Distant Localized Regional Distant
Endometrium 73 13 10 96 69 28
Cervix 51 33 8 92 52 10
Ovary 23 15 56 91 49 23