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Ovarian cancer: why is it so hard to detect?

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The scariest trait of the fifth-leading cause of cancer death among women isn’t its symptoms, but its difficulty to be detected early.

This week on “Take Care” we talk to Dr. Martee Hensley, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, on the topic of ovarian cancer. Dr. Hensley's practice focuses on the care of women with gynecologic cancers.

While there is more than one type of ovarian cancer, Hensley says epithelial ovarian cancer is the most common.

“When people talk about ovarian cancer, what most people talk about [is] what we call epithelial ovarian cancer and that is a carcinoma that rises from the surface epithelium to the outer layer of the ovary,” said Hensley.

“But other portions of the ovary can be cancerous; those tumors are much less common than granulosa cell tumors, for example, that happen mostly in post-menopausal women. But germ cell tumors that can happen in young women are a different disease than epithelial cancer, and with a much more favorable prognosis.”

One of the main reasons people don’t get checked for ovarian cancer early is that due to the roominess of the pelvis, symptoms don’t occur until the tumors are large.

“A small tumor would not cause pain or even be palpable. By the time a tumor would be large enough to cause bloating and pain, the accumulation of fluids in the abdomen, the disease is probably more advanced, and in that sense it is difficult to find at early stages,” said Hensley.

Tests and procedures are available to help detect ovarian cancer before serious symptoms occur.

“A sonogram can be quite helpful, the ovaries can be seen well on sonogram and when they have abnormal appearance that can be indication that a cancer might be present,” said Hensley. “The best kind of sonogram to do is called a ‘trans-vaginal’ where the probe goes inside the vagina that way you can image the ovaries much better.”

Hensley generally recommends that if diagnosed with ovarian cancer, patients should get surgery. This surgery should be performed by a gynecological surgeon, and would entail removal of all the visible tumor and both ovaries.

There are other things women can do to help reduce the risk of ovarian cancer. Epidemiological data has shown that high fat diets are associated with an increased risk of the disease.

“So eating well and maintaining a healthy weight and a healthy lifestyle are certainly things that will not harm and may help. If a woman is seeking some form of contraception, and the birth control pill is a reasonable option for her, that is an intervention that has been associated with a decreased risk,” said Hensley. 

There are things women can do that may help reduce the risk of ovarian cancer. Epidemiological data has shown that high fat diets are associated with an increased risk of the disease.

“So eating well and maintaining a healthy weight and a healthy lifestyle are certainly things that will not harm and may help. If a woman is seeking some form of contraception, and the birth control pill is a reasonable option for her, that is an intervention that has been associated with a decreased risk,” said Hensley. 

About 22,000 women in the United States are diagnosed with epithelial ovarian cancer a year.