July 22, 2004
Cluster of symptoms aids earlier diagnosis of ovarian cancer
Ovarian cancer has often been called the silent killer because it’s so hard to detect. New research indicates that ovarian cancer may not be silent, and both women and their health-care providers should be alert for symptoms.
UW researchers led a study that indicates certain symptoms may indeed herald the presence of the cancer. But because the symptoms are so common, the most important message is that women should be sure to discuss unusual and frequent clusters of symptoms with their health-care providers.
“Women should listen to their bodies and discuss concerns with their health-care providers,” said Dr. Barbara Goff, UW professor of obstetrics and gynecology and lead author of a paper about the findings published in the Journal of the American Medical Association.
The authors looked at previous research that found that 80 to 90 percent of women with early-stage ovarian cancer reported symptoms for several months prior to diagnosis. However, because the symptoms are common and may be related to problems unrelated to cancer, it is important for the patient to open up a dialogue. The second author, Dr. Lynn Mandel, a UW medical educator in obstetrics and gynecology and lecturer in the Department of Medical Education and Biomedical Informatics, stressed that the results of this study should not scare patients. Rather, the results should make both patients and physicians more cognizant of symptoms to evaluate, as well as lead to improved communication.
The survey found that the symptoms most common in women who turned out to have ovarian cancer were bloating, increased abdominal size, fatigue, urinary urgency, abdominal pain, and pelvic pain. These are common symptoms for healthy women as well. However, when compared with women visiting two primary care clinics at the UW, those with ovarian cancer were significantly more likely to have bloating, increased abdominal size, urinary urgency, and/or abdominal or pelvic pain. They also had a significantly greater number of symptoms (a median of eight versus four for the clinic patients).
Frequency and recent onset are also important clues. Women with tumors typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or the control group participants. The combination of bloating, increased abdominal size, and urinary symptoms was found in 43 percent of those with cancer but in only 8 percent of those reporting to primary care clinics
The authors stress that these symptoms affect most or all women at one time or another, and are by no means an automatic diagnosis. Typically, symptoms occur two to three times per month and are often associated with menses.
Ovarian cancer is the fifth-leading cause of cancer deaths among women overall after lung, breast, colorectal, and pancreatic. Every year, approximately 23,000 women are diagnosed as having ovarian cancer, and 14,000 women die of the disease. One reason for the relatively high case-fatality rate is failure to identify early-stage disease. The identification of early symptoms is important because five-year survival for early-stage disease is 70 percent to 90 percent, compared with 20 to 30 percent for advanced-stage disease.
Symptoms and risk factors
Women should check with a physician or other health-care professional if they have one or more of these new symptoms which persist for more than three weeks:
Abdominal swelling or bloating
- Abdominal or pelvic pain or pressure
- Gas, indigestion, nausea or changes in bowel habits
- Vaginal bleeding or discharge
- Urinary urgency, burning or spasms
Risk factors for ovarian cancer:
- Family history of ovarian or breast cancer
- Never bearing children
- Caucasian race
- Jewish descent
- Starting periods at a young age
- Menopause at an older than average age
- High-fat diet
Factors that lower the risk of ovarian cancer:
- Use of birth-control pills
- Having many children
- Breast feeding
- Tubal ligation
- Removal of ovaries
For more information on ovarian cancer, the authors suggest visiting the Gynecologic Cancer Foundation Web site, which is part of the Women’s Cancer Network, at http://www.wcn.org