Menopausal Ovarian Cancer
Ovarian cancer is one of the most lethal of malignancies because it usually strikes women who are menopausal and thus have no signs of reduced ovarian function. The cancer then spreads far before there are symptoms. Unfortunately, clinical exam rarely detects early disease.
Transvaginal ultrasonography (TVS) performed in conjunction with a pelvic exam can be used to detect early enlargements of the ovary in women who have no symptoms. TVS is very sensitive in detecting abnormal ovarian volume and form. When an enlarged menopausal ovary is found by TVS, blood biomarkers can identify those patients whose ovarian tumors are at high risk for malignancy. This allows us to determine which patients should be sent to an oncologist for evaluation without choosing patients whose ovaries have only benign growths. Ovarian screening for menopausal women allows early detection of some (but not all) cancers, thereby allowing treatment to be initiated when the disease is most curable.
This is not a rare problem. The lifetime incidence of ovarian cancer is about one in seventy women. In 20 years I have found five early ovarian cancers; each of those women went to the oncologist with early disease and each of them is alive today.
We recommend ovarian screening to all women in our practice with an increased risk of the disease (meaning, a personal or family history of ovarian, breast, colon, uterine or pancreatic cancer) and to women who wish to have it done. Because the procedure is rarely reimbursable, we integrate it into the annual exam and ask the patient only for a nominal fee to cover the cost of materials and equipment. No patient is obliged to have the screening and no women is denied it if she would like it.