Not. The Pap smear only detects cervical cancer. Ovarian cancer is the most difficult gynecological tumor to discover. The initial evaluation is performed by ultrasound of the abdomen and pelvis or the transvaginal examination and computed tomography of the abdomen and pelvis. According to the results, the doctor may order a biopsy of the ovarian tissue for the definitive diagnosis.
Several lines of thought suggest the existence of a correlation between the presence of Polycystic Ovary Syndrome (PCOS) and an increased risk of developing ovarian cancer. There are few studies considering this association and their results are conflicting.
On the one hand, some authors argue that anovulation itself, the main consequence of PCOS, is related to the development of malignant ovarian neoplasms. Another current, however, advocates the opposite extreme. According to them, the hyperfunction of the ovaries would be the great villain of this story. That is, with the frequent use of ovulation inducers, a common practice in the treatment of infertility in these women, the risk of developing cancer becomes greater.
Whatever the reason, the fact is that apparently patients with PCOS are more affected by the problem. The risk is small and there is no formal recommendation for an ostensive follow-up of this subgroup of women.
The first period is a milestone in the lives of most women, as it represents the beginning of the fertile phase. Menopause, in turn, occurs when the ovaries stop producing eggs and represent the end of female reproductive capacity. It usually occurs between 40 and 50 years of age and, if it starts before 40, it is called early menopause.
With ovarian failure, the body begins to produce smaller amounts of female sex hormones. The decrease in estrogen and progesterone levels causes irregularities in the menstrual cycle. As time goes on, ovulations and menstruation get progressively more scarce, until one day they stop. The main symptoms caused by this hormonal imbalance include hot flashes, night sweats, vaginal dryness, loss of sexual appetite, mood swings and insomnia, among others.
Estrogen exerts trophic effects on the entire female reproductive system, including the uterus, breasts and ovaries. Young people who menstruate for the first time before the age of 12 and also women who enter menopause later, after the age of 50, remain longer under the proliferative effects of this hormone. Thus, by stimulating breast and endometrial growth and by inducing ovulation activity, prolonged estrogen exposure is related to the development of neoplasms, such as breast, endometrial and ovarian cancer.
In view of the above, in response to the questioning, in theory, early menopause has the opposite effect: by interrupting estrogen production earlier, the woman is subjected to its stimulant effects for less time. Which makes it, in a way, more protected from the development of ovarian neoplasms. Other factors that theoretically reduce the risk are: pregnancy before age 26; have carried at least one pregnancy to term; breastfeeding and tubal ligation.
Infection by the Human Papilloma Virus (HPV) was recently identified as a necessary cause for the development of cervical cancer. Ovarian tumors are among the most common and lethal types of neoplasms of the female genital tract and their etiology remains unknown. Thus, establishing its relationship with HPV infection has been the subject of several scientific studies, with highly controversial results. While series report finding a virus-derived oncogenic product in ovarian cancers, other publications are vehement in denying this association.
So far, the presence of HPV is relevant, especially in the organs directly involved in sexual intercourse, the way in which it is transmitted. In most tumors of the penis, vulva, vagina, cervix, anal canal, and oral cavity, high-risk viral subtypes are identified. However, in light of current knowledge, despite suspicion and conflicting results, this statement cannot yet be proven for ovarian cancer.
In about 75% of ovarian cancer cases, the diagnosis occurs in stages III and IV, which are more advanced. For these women, extensive surgery, with removal of the uterus, ovaries and uterine appendages becomes the best therapeutic strategy, and, at the same time, makes them unable to bear a child. Unfortunately, this is the price one pays in search of the best chance of a cure. Fortunately, most diagnoses are made in patients over 50, often with an established family.
Sometimes, however, when early tumors are identified in women who have yet to conceive a child, removing just one of the ovaries, which would preserve fertility, may be discussed. This is a delicate subject and one that involves a balance of potential risks and benefits. Each case is a separate challenge and its feasibility must be individualized. For everything to go as smoothly as possible, it is important to be well advised by a multidisciplinary medical team that has the ability to handle this situation.