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Dr Ravichandran Nadarajah,Consultant, Department of Obstetrics & Gynaecology, Singapore General Hospital (SGH), a member of the SingHealth group shares on the different typs of screening for ovarian cancer.

Types of screening for ovarian cancer

Family history

The initial screening evaluation should include specific and personal questions about family history in relation to cancers, in particular ovarian cancer.

Physical examination

It is possible to detect ovarian cancers during a physical examination. However, it is very rare to detect early stage tumours due to the location of the ovaries in the female body. Thus, tumours detected by physical examination are always at an advanced stage and have a poor prognosis.

CA 125 marker

The measurement of the CA 125 marker is the most widely used method of screening for ovarian cancer. However, it isn’t recommended for screening for women with an average risk of ovarian cancer since an elevated CA 125 level doesn’t always mean the presence of ovarian cancer. Some women with ovarian cancer never have an elevated CA 125 level.

In early stage ovarian cancer CA 125 can be normal. Additionally, many other conditions can cause an elevated CA 125 level such as endometriosis, liver cirrhosis, diverticulitis, normal menstruation, pregnancy, uterine fibroids. CA 125 levels are elevated in 90 per cent of patients with advanced disease, but in only 50 per cent of those with stage 1 tumours.

Pelvic ultrasonography

An abdominal or transvaginal ultrasound can be used to help diagnose ovarian cancer. Transvaginal ultrasonography has proven to be more beneficial as it can help show whether the ovaries are the right size, look normal in texture or have any cysts.

Risk of malignancy index

To decide if an abnormality is more likely to be cancer or not, a tool called the risk of malignancy index is also used. This index combines the results of the ultrasound, CA 125 blood levels and menopausal status and gives doctors a final sc​​ore. Women with a high score are referred to a tertiary centre for further tests. Surgery may be necessary.

“Although screening itself doe​sn’t improve survival rates, a more multimodal screening is encouraged with hopes of catching the condition at an earlier stage,” says Dr Ravichandran Nadarajah, Consultant with the O&G Department at SGH.

Ref: Q15