When ovarian cancer is detected early, it usually can be treated successfully. Patients whose cancer hasn’t spread have at least a 90 percent chance of surviving five years.
The bad news is that the symptoms for this cancer are usually “silent”—they tend to be mild, vague and hard to detect—so the cancer isn’t found early enough in many cases. The American Cancer Society estimates that 21,650 new cases of ovarian cancer will be diagnosed this year  and that 15,520 women will die of it.
In addition to symptoms being silent, risk factors are not well defined. There’s no clear link between any one risk factor and ovarian cancer, the way there is between smoking and lung cancer, for example. The leading risk factor is heredity. It accounts for about one in 10 cases. Thus, women should be aware of all relatives who have had ovarian cancer, going back as many generations as possible. Women at highest risk of all are those with two or more “first-degree” relatives (a mother, sister or daughter) who have had ovarian cancer. For these women, the odds of getting ovarian cancer may be as high as one in two (as compared to about one in 57 for someone who has no afflicted relatives).
Women with a history of being unable to become pregnant and those who have been diagnosed with breast, uterine or colon cancer seem to have a higher than normal risk of ovarian cancer, too. On the other hand, women who have had children or used birth control pills seem to be protected somewhat from ovarian cancer.
Women with a strong family history of ovarian cancer face a quandary. Should they be tested regularly for ovarian tumors? Ultrasound and a blood test called CA125 are both used for detecting these tumors at an early stage. Ultrasound can be helpful because cancerous tissue has a distinctive look. The blood test detects elevated levels of the chemical CA125, which could mean cancer.
One promising option for women with a strong family background of ovarian cancer may be to enroll in a genetic testing program. Major cancer-research centers that do “gene-mapping” or “gene-linkage” studies can pinpoint with reasonable certainty women who have a gene that predisposes them to ovarian cancer. Women who have this gene might want to consider an oophorectomy—removal of the ovaries—as the closest thing to definitive preventive measures.
Unfortunately, even when abnormal results from ultrasound and the CA125 blood test are taken together, they still may not give a doctor enough information to know whether a woman has cancer. To determine that, exploratory surgery may be needed.
Because 90 percent of women who develop ovarian cancer don’t have a strong family history of it—and because the importance of other risk factors isn’t well established—the advice is simple: Get a pelvic exam every year. During these exams, an enlarged ovary may be detected, alerting your doctor to the need for further evaluation. Quite simply, regular pelvic exams are the best way to detect ovarian cancer at any early stage, when the chances are high that it can be cured.