Ovarian Cancer Treatment and Concerns

Occasionally patients will come in requesting a "cancer test" to screen them for "female" cancer. They are usually referring to the CA-125 blood test. There have been many stories written in magazines and viewed on television encouraging women to see their physician to have this test performed and check them for cancer. This article is written to help correct some common myths about checking for "female" cancer and the appropriate way to be evaluated.

Ovarian Cancer: CA-125 and Ultrasound

First, it is important to understand the difference between screening tests and diagnostic tests. Screening tests are the familiar procedures that are recommended for all healthy people, such as pap smears for all women, cholesterol assay, dental exams, blood pressure checks for all adults, etc. Screening tests are cheap and easy to do, and they have, by definition, been proven to save lives because they detect common mild or early abnormalities that, if treated, prevent bigger problems such as cervical cancer, heart attack, tooth loss, stroke, etc. The screening test does not provide much information in itself other than to say that further investigation of the situation by diagnostic testing is needed to see if a real problem exists and to see what treatment may be needed.

When Should an Ovarian Cancer Test Be Prescribed?

A diagnostic test is prescribed in response to an abnormal finding from a screening test or for a patient with a significant symptom or significant abnormal finding on an exam by a clinician. Most blood tests, x-rays, and procedures are considered diagnostic tests and the results must then be reviewed in the context of a long list of possible abnormalities.

The CA-125 blood test, an ultrasound, and the "total body scan" are all considered diagnostic tests, not screening tests, because they don't provide highly useful information when used by the larger population which has no abnormal finding of a screen, abnormal finding on an exam or abnormal symptom. Administering diagnostic tests to the larger population has been shown to provide few people value because of the low likelihood of finding an abnormality, often results in many false positive findings, and costs much.

One example would be taking a trip to Las Vegas in order to make money by gambling. Most everyone loses money, but one or two find great wealth. These three tests mentioned above have been researched well as proposed screening tests for the larger healthy population, and the results consistently show that there is little value to most in their use without symptoms, exam findings, or screening test indications. Many women find value in the reassurance that the above tests if normal will provide, and they can afford to pay the fee for this reassurance.

The research shows that there are likely to be very few revelations by diagnostic tests used in a screening context that will save peoples lives or result in dramatic benefit. Everyone knows of some one person, from thousands taking the Total Body Scan, in whom a mass is found and whose subsequent surgery saved their life.

Ovarian Cancer; more detailed information »
This PDF covers all of this material:

Regarding Ovarian Cancer, CA-125 and Ultrasound
  • CA-125: Good for Diagnosis, Not useful in Screening
  • Ultrasound: a valuable, non-surgical diagnostic tool
Ovarian Carcinomas
  • Borderline Tumors of the Ovary
    • Therapy for Borderline Ovarian Tumors
    • Prognosis
  • Malignant Epithelial Ovarian Neoplasms CAP LETTERS
    • The FIGO Staging for Primary Carcinoma of the Ovary (1985)
    • Mechanism of spread:
  • Surgical Management and Staging
    • ChemoTherapy for invasive epithelial carcinoma of the ovary
    • Second Look: Not standard
  • Metastatic Disease to Ovary
    • Pseudomyxomatous Peritonei Carcinoma
    • Pseudomyxoma ovarii-conditin limited to ovary

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