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Friday, December 15, 2006

Early ovarian cancer not detectable

Ask Dr. H Mitchell Hecht
Q: I received an e-mail that is circulating around, imploring women to insist on an annual CA-125 blood test for the detection of ovarian cancer. The e-mail said it’s kind of like the female equivalent of the PSA test men get for detecting early prostate cancer. Is this true?
A: It was a well-intentioned but inaccurate e-mail warning. Currently, there are no commercially available screening tests for detecting early ovarian cancer. The CA-125 blood test measures a protein released from ovarian cells, but it is neither sensitive enough to pick up an early cancer (studies show it can only detect early cancer 20-57 percent of the time) nor specific enough (it can be falsely elevated because of endometriosis, pelvic infection, uterine fibroids, liver disease, pancreatitis and even ovulation) to be clinically useful as a screening test.
The only approved use of the CA-125 blood test is in women with known ovarian cancer to monitor treatment response or recurrence.
For women of high risk, gynecologists may still order a CA-125 test along with a transvaginal ultrasound at the time of their gynecological exam. Always pay attention to persistent vague abdominal symptoms of bloating that have not been explained by irritable bowel syndrome or constipation. If colonoscopy and X-rays don’t explain your symptoms, be sure your doctor scans your ovaries and abdomen.
Good news: There may be a screening test for ovarian cancer within the next few years from Correlogic Systems — the OvaCheck blood test ( www.correlogic.com) is under review by the FDA.
Q: I have suffered with low back pain since I injured it eight months ago while lifting heavy furniture. I’ve been diagnosed with an L4/L5 herniated disc by MRI. I’ve had several months of physical therapy and am still in pain. A neurosurgeon who reviewed my MRI isn’t sure that surgery will help me. Wouldn’t you think that surgery is my best option?
A: I can’t really comment specifically on your disc herniation, but I can tell you that back surgery isn’t necessarily the best option for a herniated lumbar disc. That may come as a surprise, but a number of studies comparing surgical treatment with non-surgical treatment don’t show a strong superiority of one treatment approach over the other when it comes to either lumbar disc herniation or spinal stenosis.
Symptoms related to low back disc herniation can regress over time in the absence of surgery. Physical therapy, home exercises, epidural injections and pain medication are effective treatment modalities for a number of people.

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