Ovarian Cancer

with Sandra Gottwald, M.D., Obstetrician/Gynecologist, Advanced Healthcare

Posted: March 1, 2005

Ovarian cancer is not the most common of the gynecologic cancers, nor is it the most common cause of cancer-related deaths. More women succumb to lung, colon and breast cancer than ovarian cancer.

Because ovarian cancer is generally quite advanced when finally detected, however, it is viewed as a larger threat. Dr. Sandra Gottwald, an obstetrician/gynecologist with Advanced Healthcare, states that although there is a 95 percent chance of surviving the disease if caught in its early stages, few women who contract the disease are diagnosed at that point.

“By the time we detect 75 percent of the cases, they’re very advanced,” she said, adding that no simple or reliable test currently exists for catching ovarian cancer in its early stages.

Sandra Gottwald, M.D., Obstetrician/Gynecologist, Advanced Healthcare "Unfortunately, most of the time when we diagnose ovarian cancer, a woman will have had vague symptoms for more than three months."

Many women request a CA-125 blood test, which has become commonly known due to exposure on television, in movies and other mass media. Dr. Gottwald cautions, however, that the test is notoriously unreliable as an initial screening tool.

“The CA-125 test can be associated with non-gynecologic conditions, such as fibrosis of the liver, lung disorders and non-cancerous gynecologic conditions, such as fibroids, endometriosis and pelvic inflammatory disease,” she said. “Even simple menstruation can cause it to go up. In addition, CA-125 is only associated with a specific type of ovarian cancer.”

Dr. Gottwald cited a research study in which 22,000 women not at risk for ovarian cancer received the CA-125 screen, followed by a pelvic ultrasound if the test was positive. More than 98 percent of the women had normal results. Within a year, four of those women were diagnosed with Stage II and Stage III ovarian cancer, abnormalities that had not been present in the initial screen.

The reality, she said, is frustrating for both doctor and patient.

“Unfortunately, most of the time when we diagnose ovarian cancer, a woman will have had vague symptoms for more than three months,” she said.

Signs of ovarian cancer can include an increase in abdominal size, bloating, a sense of fullness after eating or indigestion. Nausea, weight loss, constipation, urinary frequency, incontinence or pain during intercourse may also be present.

Although it can strike a woman at any age, most individuals who contract ovarian cancer are post-menopausal. Other risk factors include a mother or sister with the disease (only five to 10 percent of women diagnosed with ovarian cancer fit this category), a family or personal history of breast, endometrial, prostate or colon cancer, unexplained infertility or lack of childbearing. North American or North European heritage and/or Eastern European (Ashkenazic) Jewish heritage may also pose a certain risk.

That said, according to the National Cancer Institute, a woman with no family history of ovarian cancer has a 1.8 percent chance of developing the disease during her lifetime. That number rises to between 4 and 7 percent if she has a first-degree relative with the disease. In families where there is a strong pattern of ovarian, breast and other cancers, that number can increase significantly.

Because early-stage ovarian cancer is hard to catch, women persistently experiencing any of the symptoms mentioned above should schedule an appointment with their primary care physician or ob/gyn to discuss their concerns.

As for preventive measures, birth control pill use and childbearing appear to be protective, possibly by decreasing ovulation, which disrupts the ovarian membrane. This is theorized — in predisposed individuals — to be one possible mechanism for ovarian cancer.

Dr. Gottwald encourages women to know their own bodies and family medical history. They should be screened regularly for cancers that have more reliable testing options. This would include Pap smears for cervical cancer, colonoscopies for colon cancer and mammograms for breast cancer.

Dr. Sandra Gottwald
414-352-3100
Good Hope Road Clinic
3003 West Good Hope Rd.
Milwaukee

262-375-3700
Cedar Creek Clinic
215 West Washington St.
Grafton

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