Elizabeth Diaz Cox, MD
Board Certified Obstetrics/Gynecology
College Hill Obstetrics & Gynecology
316-683-6766
Q & A - Women's Health Questions Answered
Question: What are the potential symptoms of ovarian cancer, and what are the best methods to screen for ovarian cancer?
Ovarian cancer is one of the deadliest cancers in women, in part because it is often found at late stage. There is a great deal of interest in finding a test or combination of tests that could detect ovarian cancer at an early, treatable stage. However, studies have not yet shown that screening tests decrease the risk of dying of ovarian cancer. Until more studies are completed:
-Women with no family history of ovarian cancer are advised to not have ovarian cancer screening.
-Women with a "high risk" family history of ovarian cancer are at increased risk of ovarian cancer. Women with a particularly high risk may benefit from ovarian cancer screening.
Factors that increase your risk of ovarian cancer include the following:
-Older age
-Having one or more relatives with ovarian cancer
-Having abnormalities in a gene, called BRCA1 or BRCA2
-Having genes that are linked to hereditary nonpolyposis colorectal cancer (also called Lynch syndrome)
-Never being pregnant
-Being overweight
Some factors can reduce your risk of developing ovarian cancer, including:
-Using hormonal methods of birth control (pills, patch, vaginal ring, injection)
-Being pregnant, breastfeeding
-Having your tubes tied to prevent pregnancy
-Having your uterus or ovaries removed
Studies are being done to find the best combination of screening tests for ovarian cancer. Tests that may be useful for women at high risk of ovarian cancer include a blood test of the CA 125 tumor marker, ultrasonography, or a combination of the two.
CA 125 tumor marker — CA 125 is a protein that is higher than normal in approximately 80 percent of women with ovarian cancer. It can be measured with a blood test. CA 125 is commonly used to monitor women with ovarian cancer.
It was hoped that CA 125 could be used to know if a woman was at risk for ovarian cancer. However, CA 125 levels can be high with a variety of other conditions, including:
- Endometriosis
- Uterine fibroids
- Liver disease (cirrhosis)
- Pelvic infections
- Other cancers, including endometrial, breast, lung, and pancreatic cancer.
Also, CA 125 levels are higher than normal in about 1 percent of healthy women, and the levels change during the menstrual cycle.
Screening should be offered in a woman with a "high-risk" family history who has a strong family history of breast or ovarian cancer in more than one relative or has family members with cancer who have certain characteristics. If you have a BRCA mutation and you have your ovaries, or you have Lynch syndrome and have your ovaries.
During the early stages of ovarian cancer, symptoms are often vague and ill-defined. Symptoms may include pelvic or abdominal discomfort, bloating, difficulty eating or feeling full, increased abdominal size, or rushing to urinate frequently.
Question: At what age should a woman receive her first pap smear and pelvic exam?
A pap smear is a test done at the time of a pelvic exam, however your first pap smear should start at the age of 21, and a pelvic exam is a procedure done for various reasons. Reasons include but are not limited to painful periods, abnormal vaginal discharge, abnormal bleeding, pelvic pain, sexually transmitted disease testing, pelvic mass, ovarian cyst, etc. Therefore one might have a pelvic exam done at the age of 16 for the reasons above, however not yet need a pap smear.
The Pap smear is a test used to screen women for cervical precancer or cancer.
Pap tests find cervical cancer and precancer in the early stages when it can be treated, and thus may reduce the number of deaths from cervical cancer.
The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). There are over 100 different types of HPV, however most types of HPV do not cause cancer. At least 80 percent of women are exposed to the HPV virus during their lifetime. Most of the time, the body's immune system gets rid of the virus before it does harm.
HPV is spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand to genital contact). In 2006, a vaccine became available in the United States to help prevent infection with certain strains of HPV.
Most people who are infected with HPV have no signs or symptoms. Most HPV infections are temporary and resolve within two years. When the virus persists (in 10 to 20 percent of cases), there is a chance of developing cervical precancer or cancer. However, it usually takes many years for HPV infection to cause cervical cancer.
The Pap test is a method of examining cells from the cervix. To perform a Pap test, a doctor or nurse will perform a pelvic exam and use a small brush or spatula to collect cells from the cervix.
Question: My husband and I have been trying to conceive our first child for almost a year now. Is this common? What do you recommend to improve our chances?
Infertility is defined as the inability of a couple to become pregnant after one year of unprotected intercourse. Infertility is a common condition: in any given year, about 15 percent of the couples in the United States who are trying to conceive are not able to do so.
Because fertility involves a complex interaction of male and female factors, healthcare providers routinely involve both partners in the evaluation.
The evaluation of male infertility may point to an underlying cause, which can guide treatment. A healthcare provider usually begins with a medical history, physical examination, and a semen test. Other tests may be needed.
A man's past health and medical history are important in the process of evaluation. A healthcare provider will ask about childhood growth and development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility testing.
Other conditions that might affect fertility include:
-Varicocele, a varicose vein of the testicle
-Absent vas deferens or thickening of the epididymis
A semen analysis (sperm count) is a central part of the evaluation of male infertility. This analysis provides information about the amount of semen and the number, motility, and shape of sperm.
A testicular biopsy (collection of a small tissue sample) may be recommended in men with no sperm on the semen analysis.
Although a variety of tests are available for evaluating female infertility, it may not be necessary to have all of these tests. Healthcare providers usually begin with a medical history, a thorough physical examination, and some preliminary tests.
A woman's past health and medical history may provide some clues about the cause of infertility. The healthcare provider will ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.
A physical examination, blood tests to assess ovarian function and ovulation and other hormone levels, a menstrual history and tests to evaluate the uterus and fallopian tubes, such as an HSG (hsyterosalpingoram) to identify structural abnormalities of the uterus and tubes. Other tests could possible include a pelvic ultrasound, a surgical procedure such as a laparoscopy to diagnose endometriosis or pelvic adhesions (scarring).
Genetic testing may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility.
Identifying the cause of infertility is the first step in order to figure out the best chances of becoming pregnant.