How hard is it to find early OC if they are looking???

Dr. Goodman -

I am terribly frightened that I have OC and it is being overlooked and won't be found until it is advanced.

I understand most cases of ovarian cancer are caught at a later stage because either a.  patients don't know what symptoms to look for and/or b.  doctors  might look at alternative diagnoses without putting much thought into ovarian cancer. since other things are so common  I understand that is why so many of the cases are caught at an advanced stage.

My question is whether or not it is common that these cases are caught late because doctors (and patients) 'miss' it while looking for OC in particular???   As you will see from another post, I have been ill since October, though had a brief 3 month break where I was fine.  In December, I had all negative tests (transvaginal ultrasound, CT, CA125 of 32 and ultimately, exploratory laproscopic surgery finding no tumors or evidence of cancer).   Fastforward to April, where my CA125 is up to 46, normal t/v ultrasound again, and symptoms remain. I am 44 years old, no family history of any cancer.   Is it possible that even with the lapro surgery that something could have been missed?   Could it have been so small that it would have been missed in a very early stage?    Since only four months have passed, if something was there, how likely would it be that it would be advanced enough to 'see' now?  I don't know that my doc would agree to another lapro so soon, or if it would even reveal anything in such a short time.

Please help.  I am having severe anxiety over this and am losing my ability to function.

MM

[Annekathryn Goodman, M.D.]

Hi There
sadly, we do not have an effective screening test for ovarian cancer. If a person has risk factors for ovarian cancer such as a family history of 2 or more first degree family members with ovarian cancer or a personal history of BRCA gene mutation, that is a reason to undergo the prophylactic surgical removal of the ovaries and fallopian tubes.

I have pasted the official recommendations for ovarian cancer screening from the American College of OB GYN (ACOG)

you have had a thorough normal evaluation , the likelihood of cancer is low. I wonder if you need intervention for your anxiety. What ever the future holds, all you can do is live your life to the fullest today.   I hope you are able to get help for your disabling anxiety.
take care

  from ACOG Bulletin:
Unfortunately, there is no screening test for
ovarian cancer that has proved effective in screening
low-risk asymptomatic women. Measurement of
CA 125 levels and completion of pelvic ultrasonography
(both abdominal and transvaginal) have been
the two tests most thoroughly evaluated. One group
of researchers evaluated 22,000 women with
CA 125 screening, followed by pelvic ultrasonography
if an elevated tumor marker was present (2, 3).
More than 98% of women had normal CA 125 values.
Of the remaining group, 41 (0.1%) had both
increased CA 125 values and abnormal ultrasonograms
and underwent surgical assessment. Only 11
women (0.05% of women screened) had ovarian
cancer, which was stage III in 7 women. The falsepositive
rate among those undergoing surgery was
73%. Another group of researchers evaluated 14,469
asymptomatic women with transvaginal ultrasonography,
performing 57,214 scans over a period of several
years (4). During the period of evaluation, only
11 of 180 women who had surgery for abnormal
adnexal masses (6% of operations and 0.07% of
women screened) had primary epithelial ovarian
cancers, 6 of whom had cancers beyond stage I.
Unfortunately, 4 additional women developed primary
epithelial ovarian cancers (stage II and stage
III) within 12 months of a normal scan. In a mass
screening study of 51,500 women conducted over
several years using transvaginal ultrasonography,
324 women were identified with abnormalities
requiring surgery (5). Only 17 of these women (5%
of operations and 0.03% of women screened) were
found to have primary epithelial ovarian cancers.

be
approximately one case per 2,500 women per year,
it has been estimated that a test with even 100% sensitivity
and 99% specificity would have a positive
predictive value of only 4.8%, meaning 20 of 21
women undergoing surgery would not have primary
ovarian cancer. Unfortunately, no test available
approaches this level of sensitivity or specificity.
Hereditary ovarian cancer is estimated to represent
only 5–10% of all ovarian cancers. Based on
current data, a woman with a germline mutation of
BRCA1 or BRCA2 has a lifetime risk of 15–45% of
developing ovarian cancer. There are no data
demonstrating that screening improves early detection
of ovarian cancer in this population. These
women should be offered genetic counseling to
address issues that relate to their high risk of breast
and ovarian cancer and the potential impact of these
genetic mutations on their offspring. Even if this
group were screened for ovarian cancer on a regular
basis, more than 90% of all potential ovarian cancer
patients would remain unscreened.
Despite varying recommendations regarding the
frequency of cervical cytology screening, the
Committee on Gynecologic Practice and the Society
of Gynecologic Oncologists still believe that an
annual gynecologic examination with an annual
pelvic examination is recommended for preventive
health care. Although newer tumor markers and proteomics
are undergoing investigation and appear
promising for screening, it is unclear whether they
will help identify high-risk women or facilitate the
early diagnosis of more women with ovarian cancer.
Currently, there are no techniques that have proved
to be effective in the routine screening of asymptomatic
low-risk women for ovarian cancer.