Ovarian cancer still lacks reliable early diagnostic test

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By Dr. Melanie Bone, Cox Newspapers 8:19 PM Friday, November 13, 2009

Q Can a woman with ovarian cancer can be diagnosed earlier if her doctor orders a CA 125 test? Conversely, I have heard that the test is not a good one and there is a new test called HE4 that is better. What do you think?

A At this time, there is no good screening test for ovarian cancer, not even the CA 125. The CA 125 test is flawed because it can be normal in a patient with ovarian cancer and it can be abnormal when there is no cancer.

I still remember operating on a young woman whose CA 125 was 1,900. The upper limit of normal is about 35. After counseling her family about the high likelihood of cancer, I was happy to find a pelvic infection had caused her abnormal blood results.

The HE4 is not very different. Neither the CA 125 nor the HE4 are designed to find cancer.

They are both used to follow patients known to have ovarian cancer. The values should go down with surgery and chemotherapy. If they start to go up again, there might be a recurrence of the cancer.

A recent British study found that the combination of a blood test (CA 125) and a pelvic sonogram together was more likely to find cancer than either one alone. Unfortunately, the cost of doing these tests on every woman is prohibitive.

Sooner or later there will be a good screening test for ovarian cancer. For the time being, I suggest listening for the ovarian cancer “whisper.”

Most women with ovarian cancer experience bloating, increased gas, a feeling of fullness after eating small amounts and some pelvic pressure or pain many months before they come to diagnosis.

Many of us tend to ignore these complaints as indigestion, stress, irritable bowel or related to our menstrual cycle.

If you have these issues, I suggest a trip to your gynecologist to rule out an ovarian problem.

Dr. Melanie Bone is a cancer survivor and gynecologist who practices in West Palm Beach. Send questions about cancer for her column to info@drmelaniebone.com. Any questions submitted will be considered for her column. Join the cancer community at Dr. Bone’s Web site: www.DrMelanieBone.com.

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