Identification of early ovarian cancer symptoms may have important clinical implications

Symptoms experienced by women that are more severe or frequent than expected and of recent occurrence warrant further diagnostic investigation because they are more likely to be associated with both benign (non-cancerous) and malignant (cancerous) ovarian masses, according to a study in the June 9 issue of the Journal of the American Medical Association (JAMA).

"Ovarian cancer has often been called the 'silent killer' because symptoms are not thought to develop until advanced stages when chance of cure is poor," the authors provide as background information in the article. The authors looked at previous research which found that "80 percent to 90 percent of women with early stage disease will report symptoms for several months prior to diagnosis." The authors continue, "Identification of early symptoms may have important clinical implications because 5-year survival for early stage disease is 70 percent to 90 percent compared with 20 to 30 percent for advanced-stage disease."

In this study, Barbara A. Goff, M.D., from the University of Washington School of Medicine, Seattle, and colleagues compared the frequency, severity, and duration of symptoms between women with ovarian masses (n=128) and women in the control group who visited two primary care clinics (n=1,709). The women were asked to complete an anonymous survey of symptoms experienced over the past year (July 2001 - January 2002). Severity of symptoms was rated on a 5-point scale, duration was recorded, and frequency was indicated as number of episodes per month.

"In the clinic population, 72 percent of women had recurring symptoms with a median (mid-point) number of two symptoms. The most common were back pain (45 percent), fatigue (34 percent), bloating (27 percent), constipation (24 percent), abdominal pain (22 percent), and urinary symptoms [urgency/frequency] (16 percent)," the researchers found. "Comparing ovarian cancer cases to clinic controls resulted in an [increased] odds ratio of 7.4 for increased abdominal size; 3.6 for bloating; 2.5 for urinary urgency; and 2.2 for pelvic pain. Women with malignant masses 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 controls. 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 presenting to primary care clinics."

"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. Typically, symptoms occur 2 to 3 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. 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 conclude.

JAMA: The Journal of the American Medical Association