Early detection key to beating ovarian cancer

BMJ GroupAug 14 2024

'Symptom triggered testing', prompted by symptoms such as pain, abdominal bloating/swelling, and feeling full soon after starting to eat, can pick up early stage aggressive ovarian cancer in 1 in 4 of those affected, finds a data analysis, published online in the International Journal of Gynecological Cancer.

And complete surgical removal of the cancerous tissue was possible in 60% of those diagnosed in this way. 

The findings challenge the assumption that symptoms always signal advanced disease in women with ovarian cancer, conclude the researchers.

Ovarian cancer is the sixth most common cause of cancer death in the UK. But while most (93%) women diagnosed with early-stage disease (I or II) survive for more than 5 years, only 13% of those diagnosed with advanced disease (stages III or IV) do so.

Mounting evidence suggests that symptoms precede diagnosis by between 3 months and 3 years, but symptoms are often vague, making early detection difficult, explain the researchers.

But symptoms such as pain, abdominal swelling and/or bloating, and feeling full soon after starting to eat are associated with ovarian cancer, and warrant urgent investigation, or 'symptom triggered testing.'

The UK adopted symptom-triggered testing for ovarian cancer in 2011. Women, especially those over the age of 50 with these symptoms, are tested for levels of the tell-tale protein CA125 in their blood and given an ultrasound scan. Abnormal results prompt a fast track referral to a gynecologist within 2 weeks. 

But how effective this protocol is for picking up early stage disease in women with high grade serous ovarian cancer-; the most common, aggressive, and lethal form of the disease-; isn't clear, say the researchers.

To find out, they analyzed data from 1741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study, which involved 24 UK hospitals. The women had all been fast tracked for treatment under the symptom-triggered testing protocol.

In all, 119 (7%) of these women were diagnosed with high-grade serous ovarian cancer. Their average age was 63, but ranged from 32 to 89; 90% had gone through the menopause. 

In most of these women (112; 94%) cancer didn't hugely interfere with their daily lives, as they were classified with a performance status of 0 or 1, meaning they were either fully active or were able to do everything but strenuous activities.

One in four (30; 25%) had early stage I or II disease. Visible cancerous tissue was completely removed in 73 (61%) and almost completely removed in 18 (15%). The disease was only deemed to be inoperable in 9 (8%). 

The extent of cancer was low in 43 of the 119 (36%), meaning that it was localized in the pelvis; moderate in 34 (29%), meaning that it had spread to the lower abdomen; and high in 32 (27%), meaning that it had spread up to any of the liver, pancreas, diaphragm or spleen. Information on disease extent wasn't available for 10 (8.5%) women.

Surgery to remove as much of the tumor as possible, which is associated with longer survival, was carried out in more than 3 in 4 (93; 78%) women, with almost two thirds (78; 65%) having surgery ahead of chemotherapy. 

Thirty six (30%) women were given chemotherapy to shrink the tumor ahead of surgery; 5 (4%) didn't have surgery; and information on this wasn't available for 17 (14%).

"Our figures demonstrate that in a real-world setting, symptom-based testing can potentially lead to diagnosis of high grade serous ovarian cancer with low disease spread and results in a high proportion of complete [surgical removal of the cancer]," write the researchers.

The findings also show that complete surgical removal of the cancerous tissue is possible even in more advanced diseases, providing that women with suspicious symptoms are expedited for investigation and treatment, they add.

"These findings challenge the assumption that the disease should always be considered to be in its advanced stages in women once they develop symptoms," they highlight. 

"More importantly, our findings emphasize the importance of increasing an awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway to improve patient outcomes."