There are currently two main methods to screen for ovarian cancer and prevent ovarian cancer!

Author: Pan Lingya, chief physician of Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Ovarian cancer, like most malignant tumors, has an unknown etiology. One widely accepted theory involves the mechanism of uninterrupted ovulation. The ovaries continue to ovulate, and the pores left after ovulation need to undergo frequent repair processes. This process may induce the malignant transformation of epithelial cells, which constitutes one of the classic hypotheses for the onset of ovarian cancer.

Based on this and other theoretical theories, the medical community has conducted extensive epidemiological studies and generally agrees on the association between fertility status and ovarian cancer risk. Specifically, multiple births, especially three or more full-term births, are believed to have a positive effect on reducing the risk of ovarian cancer. Conversely, nulliparity or fewer births is considered a potential risk factor for epithelial ovarian cancer.

Genetic studies in recent years have shown that approximately 15% of ovarian epithelial cancer is caused by genetic factors, which emphasizes the importance of genetic factors in the development of the disease.

Ovarian cancer is known as the "silent killer" because of its hidden nature. Most patients are diagnosed at an advanced stage of the disease, which is mainly attributed to its specific anatomical location.

1. Does ovarian cancer have no symptoms at all in the early stages?

In the female reproductive system, the uterus is directly connected to the outside world, so cervical cancer and endometrial cancer are often accompanied by abnormal vaginal bleeding, allowing patients to seek medical help earlier. In contrast, ovarian cancer often develops silently, lacks specific symptoms in the early stages, and is often not detected until late-stage signs such as ascites appear.

However, through in-depth epidemiological research, we have come to realize that ovarian cancer is not completely without traces. Although its early symptoms are not obvious, they do exist. Unfortunately, these symptoms are often ignored due to lack of attention and public awareness. These early signs may include discomfort in the reproductive system, such as abdominal discomfort, lower abdominal pain or bloating, and urinary system symptoms such as frequent urination and urgency. If these symptoms occur frequently within a month and accumulate for more than 12 days, they should be regarded as warning signs and you should go to the hospital for professional examination in time.

Figure 1 Original copyright image, no permission to reprint

2. Currently there are two main methods for screening ovarian cancer!

There are two main methods for ovarian cancer screening: the first is transvaginal ultrasound, which can clearly observe the condition of the ovaries; the second is ovarian cancer tumor marker testing, the most sensitive of which is CA 125. It is recommended that women over 50 years old undergo ovarian cancer screening once a year.

Figure 2 Original copyright image, no permission to reprint

However, for the general population without a family history of ovarian cancer, the current use of these two screening methods is immature and has limited effect. For people with a genetic background of ovarian cancer, it is recommended to perform transvaginal ultrasound and CA125 testing every 3 to 4 months.

Hereditary ovarian cancer and breast cancer are often caused by the same gene mutation - BRCA gene mutation. If two first-degree relatives, three second-degree relatives, or three first-degree and second-degree relatives in total have ovarian cancer or breast cancer in a family, it can be considered that the family is at risk of hereditary ovarian cancer or breast cancer, and genetic testing is recommended to confirm whether there is a BRCA gene mutation.

3. Does an increase in the tumor marker CA125 indicate ovarian cancer?

uncertain.

As a tumor marker for ovarian cancer, CA125 has high sensitivity but low specificity. Although more than 80% of ovarian cancer patients have elevated CA125 levels, this does not mean that elevated CA125 levels necessarily indicate the presence of ovarian cancer. Many benign diseases, such as endometriosis, adenomyosis, pelvic inflammatory disease, and even during menstruation, can cause a slight increase in CA125 levels. In this case, a slight increase in CA125 usually does not need to be overly worrying.

When CA125 levels are significantly elevated, especially when the value exceeds 500 U/mL, the possibility of malignant lesions should be highly suspected. Therefore, a simple increase in CA125 levels can only be used as a reference indicator for diagnosing ovarian cancer, and a comprehensive evaluation and diagnosis should be made in combination with other information such as a detailed medical history and imaging examinations.

4. Currently, these two methods are more reliable for preventing ovarian cancer!

The "Guidelines" released by NCCN (National Comprehensive Cancer Network) in 2015 clearly stated that for people carrying clear BRCA gene mutations, preventive fallopian tube and oophorectomy is recommended between the ages of 35 and 45, which is considered the most reliable method to prevent ovarian cancer.

Another method of preventing ovarian cancer that is supported by evidence-based medicine is the long-term use of oral contraceptives. Oral contraceptives can reduce the risk of ovarian cancer by inhibiting ovulation and reducing the repair of damage to the ovarian surface. This protective effect is more significant as the duration of medication is prolonged. For women who carry BRCA gene mutations but have not yet completed their fertility plans, it is also recommended to use oral contraceptives to prevent ovarian cancer if they have no desire to have children in the near future.

However, not all women are suitable for oral contraceptives to prevent ovarian cancer. The primary consideration is age, especially for women over 45 years old, who need to use contraceptives with caution because of the increased risk of thrombotic diseases. Contraceptives often contain a small amount of synthetic estrogen, which is associated with the risk of thrombotic diseases. Therefore, oral contraceptives are no longer recommended as a preventive measure for women over 45 years old.

In addition, the main ingredient of current combined oral contraceptives is progestin, which has a potential negative impact or a small risk on breast cancer. Although it is not yet certain whether oral contraceptives directly increase the risk of breast cancer, for safety reasons, breast cancer patients and people with a high genetic risk of breast cancer (such as those with a family history of breast cancer) should avoid long-term oral contraceptives.