October 5, 2021 – Ovarian Cancer encompasses cancers of ovaries, fallopian tubes, and the primary peritoneum, which is the tissue that lines the abdominal wall and covers the abdominal organs. These cancers often go undetected until they’ve reached advanced stages.
Although the overall incidence of ovarian cancer has been steadily falling during the past two decades, ovarian cancer still remains the leading cause of death from gynecologic cancers and ranks fifth in cancer deaths among women, with an estimated 14,000 women expected to die from the disease and another 21,500 to be newly diagnosed with ovarian cancer in 2021 in the U.S. Globally, 313,617 women are expected to die from the disease and 428,966 to be newly diagnosed with ovarian cancer.
As with other cancers, diagnosing ovarian cancer at an early stage leads to a greater survival rate, better than 90 percent at 5 years, hence the importance of screening for women who are at high risk for the disease. Unfortunately, most patients (approximately 70 percent) are diagnosed at an advanced stage – stage III (upper abdominal or regional lymph node metastases) or stage IV (extra-abdominal or hematogenous metastases) disease where the 5-year survival drops to between 30 and 70 percent. This vast discrepancy in prognosis and survival rate has reaffirmed the need for screening programs to maximize early detection and improve outcomes.
However, the difficulty with screening lies in the fact that even with the best intentions such as using transvaginal ultrasound, many ovarian cancers cannot be adequately detected through screening programs alone. This is because the most common tumor cell type of ovarian cancer is a high-grade serous cystadenocarcinoma, which demonstrates rapid progression with an estimated doubling time of less than 3 months thereby progressing rapidly from early- to late-stage within 4 to 6 weeks and evading early detection even with transvaginal ultrasound. Another problem is that adnexal masses are common, as opposed to ovarian cancer which remains relatively rare, making effective screening even more difficult.
Ultrasound (abdominal or transvaginal) is likely to be the first imaging technology used in the initial evaluation of a potential ovarian cancer because of its widespread availability, high resolution and lack of ionizing radiation, it is often indeterminate due to a wide range of operator expertise and patient body habitus, prompting the need for another imaging study.
Although CT scanning remains the imaging modality of choice given its wide availability and fast acquisition of images, MRI has started to supplant CT imaging because of its high contrast resolution and, as with ultrasound, lack of ionizing radiation. The overwhelming contribution of MRI in the evaluation of adnexal masses is its specificity because it is able to confidently diagnose benign adnexal pathology, thereby preventing unnecessary surgery to establish a definitive diagnosis. Therefore, women with a low clinical risk of ovarian cancer but with indeterminate findings on initial ultrasound are the ones most likely to benefit from MRI. Women who have been diagnosed with ovarian cancer can still rely on CT imaging for both staging of the disease and the evaluation of therapeutic response. Although the role of MRI is continuously evolving, it has not yet replaced CT imaging for ovarian cancer.
At Imaging Endpoints, we deploy all of these detection and evaluation methodologies as well as emerging technologies such as radiomics to work toward our mission of Connecting Imaging to the CureTM for ovarian cancer. For more information, please email us at email@example.com to learn more and arrange time to speak to one of our experts.