Study Helps Clarify Ovarian Cancer Symptoms

Physicians Learn Nuances Of Physical Complaints

 < June 9, 2004 > -- A new study reported in the Journal of the American Medical Association states that women with early-stage ovarian cancer may experience symptoms that can help a physician determine if a woman needs further evaluation.

Authors of an editorial published with the new report states that the results "lend strong support to the notion that ovarian cancer is often preceded by a set of recognizable symptoms."

The most common symptoms include back pain, fatigue, bloating, constipation, abdominal pain, and urinary symptoms.

The study "also identifies four characteristics of the symptoms that should raise clinical suspicion of ovarian cancer, namely frequency, severity, time of onset, and total number of symptoms," the editorialists write.

Dr. Kevin Holcomb, director of gynecologic oncology at Beth Israel Medical Center in New York City, says, "This is just support of what we've already seen in previous studies: that ovarian cancer is not a disease that is going to shout at you in its early stages. But there is some whispering going on and you have to be listening very carefully."

The authors of the report say, "It is important to emphasize that the majority of women who have symptoms from our list of 20 complaints will not have ovarian cancer.

"Nonetheless, this initial study gives better definition of symptoms typically associated with ovarian cancer, providing valuable information for both women and their clinicians," the researchers say. "Symptoms that are more severe, more frequent than expected, and of more recent onset warrant further diagnostic investigation. These symptoms are more likely to be associated with ovarian masses, many of which may be malignant."

The information should come as a relief to women and health-care providers alike, many of whom have resigned themselves to believing that ovarian cancer cannot be caught until it is too late.

The American Cancer Society estimates that 25,580 new cases of ovarian cancer are expected in the US in 2004. Ovarian cancer accounts for nearly 4 percent of all cancers among women and ranks second among gynecologic cancers.

Finding Ovarian Cancer Early Is Critical

When ovarian cancer is detected early, the five-year survival rate is 70 percent to 90 percent, compared to 20 percent to 30 percent for advanced-staged disease.

"While our current study did find that women who present to primary care clinics frequently have vague symptoms that can be associated with ovarian cancer, the important difference is that these symptoms are less severe and less frequent when compared with women with ovarian cancer," the study authors write in their report.

"Typically, symptoms occur two to three times per month and are often associated with menses, which may explain why these vague symptoms become less common and less severe as women age,"the authors continue.

"In addition, women with ovarian cancer typically have symptoms of recent onset and have multiple symptoms that coexist. This study adds further evidence that ovarian cancer is not a silent disease," the authors say.

Researchers Compare Complaints

The study authors surveyed 128 women with ovarian "masses" (either malignant or benign) and 1,709 women who were visiting two primary-care centers about the frequency, severity, and duration of symptoms they had experienced over the past year.

Of the women in the group visiting primary care clinics, 72 percent had recurring symptoms of various kinds, with two complaints communicated to physicians. The most common complaints were back pain (45 percent), fatigue (34 percent), bloating (27 percent), constipation (24 percent), abdominal pain (22 percent), and urinary symptoms (16 percent).

Compared with the women at the two primary care clinics, women with ovarian cancer were 7.4 times more likely to have increased abdominal size, 3.6 times more likely to have bloating, 2.5 times more likely to have urinary urgency, and 2.2 times more likely to have pelvic pain.

Women with cancerous tumors also experienced symptoms, which tended to be more severe, every day.

By contrast, women without cancer might experience symptoms two or three times per month, most often associated with their periods.

The combination of bloating, increased abdominal size, and urinary symptoms was found in 43 percent of women with cancer but in only 8 percent of those being seen at the primary-care clinics.

How do physicians translate this information into saving lives?

"It takes a careful communication between the doctor and the patient to sort out the symptoms that a woman may be reporting and evaluate them to see who deserves to go on to have an evaluation," says Dr. Mary B. Daly, author of an accompanying editorial and director of cancer prevention and control at Fox Chase Cancer Center in Philadelphia.

"This isn't going to take the place of more sophisticated kinds of screening tools that we hope will develop, but even screening tools need to be used in the context of good communications," Dr. Daly says.

"The importance of this study is not the validation of a symptom cluster as a precise way to diagnose ovarian cancer, but rather the reinforcement of the need for an ongoing process of communication between patients and their physicians," Dr. Daly writes in the editorial.

"In the absence of more definitive diagnostic tools, early detection of ovarian cancer will continue to challenge both the artistic skill of astute clinicians as well as their accumulated scientific acumen," she says.

Always consult your physician for more information.

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For more information on ovarian cancer, please visit health information modules on this Web site.

Ovarian Cancer Defined

Ovarian cancer is a disease in which malignant cells are found in an ovary.

There are three types of ovarian tumors, named for the tissue in which they are found:

• epithelial cell - cells that cover the surface of the ovary

Most of these tumors are benign. However, epithelial ovarian cancer accounts for 85 to 90 percent of ovarian cancer cases.

• germ cell - cells that form the eggs in the ovary
  
  
• stromal cell - cells that form the ovary and produce female hormones

The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer.

The following have been suggested as risk factors for ovarian cancer:

• early menarche - starting monthly periods early - before the age of 12
  
  
• late menopause (after the age of 52)
  
  
• age - over the age of 50
  
  
• hormone replacement therapy

Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer. 

• infertility - inability to become pregnant
  
  
• having a first child after the age of 30
  
  
• personal history of breast or colon cancer
  
  
• family history

First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at a risk for developing the disease. The risk increases if two or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer. 

• fertility drugs

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Always consult your physician for more information.

Online Resources

American Cancer Society

American College of Obstetricians and Gynecologists

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Cancer Institute

National Institutes of Health (NIH)