Dear Dr. Roach: In a recent column on screening tools, you made a brief statement about ovarian cancer. As a cancer survivor with metastasis to the ovary, I was hoping to have read something within the response on screening for ovarian cancer. What is your response to someone in regard to screening for ovarian cancer if she presents with symptoms?
M.L.
Ovarian cancer, like pancreatic cancer, is a dangerous and deadly cancer because it spreads early in its course, and its early symptoms are vague and often not recognized by the patient or are dismissed by her physician.
Screening, by definition, is looking for cancer or its precursor before there are symptoms.
Although many have tried (including several types of blood tests), there still are not yet any generally accepted screening tests for ovarian or pancreatic cancer. For this reason, patients and physicians need to be aware of the symptoms, as vague as they are, and be ready to evaluate those symptoms promptly in order to have a chance of finding the disease at an early enough stage to have a good chance at cure.
For ovarian cancer, those early symptoms include abdominal bloating, distention or nausea; loss of appetite; fatigue; and pelvic and back pressure. Women who notice an increase in waist size despite poor appetite should be particularly concerned and should tell their doctors of their specific concern for ovarian cancer. Many times, a careful exam and history will be enough to make the diagnosis very unlikely, but other times a sonogram or CT scan may be necessary, especially in women at higher-than-average risk of the disease (older age, history of high-dose estrogen use and family history).
For pancreatic cancer, upper abdomen pain radiating to the back, unexplained weight loss and fatigue are common early symptoms. Jaundice (yellowing of the body, usually first seen in the mouth or eyes) without abdominal pain often is the first clear sign, and the cancer is unfortunately often quite advanced at that time.
As soon as a proven screening test becomes available, I will write about it.
Dear Dr. Roach: I am 66 years old. Pap smears are no longer recommended for me. My gynecologist is moving out of the area. I asked my post-menopausal friends who they see for gynecological issues, and they say they see their general doctor. Do I need to have a gynecologist in the future?
Anon.
Gynecologists have high levels of expertise on women's health issues. However, for women over 65, the woman’s general doctor, such as an internist or family medicine doctor, might have the experience to do routine gynecological care.
While a Pap smear is not necessary, there are other gynecological issues that are common in women over age 65.
These include atrophic vaginitis (due to the reduction in estrogen levels, the lining of the vagina can thin, leading to dryness, itching and discomfort) and uterine bleeding.
Having a physician who is expert in evaluating symptoms is important at any age. It is reasonable for you to ask your general physician if he or she is comfortable with providing gynecological care, and if not, to find a gynecologist who is.
Not all general providers are experts at gynecological care and might not ask about symptoms. I have seen many women over 65 with gynecological issues that were never properly evaluated by their general doctor.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
