US cancer groups highlight symptoms of early ovarian cancer
Janice Hopkins Tanne

New York

Women in the United States should watch out for the early signs of ovarian cancer, which have been described in a consensus statement from the American Cancer Society, the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists.

Ovarian cancer is often called the "silent killer" because it is thought to have no early warning signs and is usually detected when it has already spread beyond the ovary. Although when the disease is detected early about 93% of women survive for five years, only 19% of cases are found that early, the American Cancer Society said.

About 15 000 US women will die from the disease this year, and about 22 000 new cases will be diagnosed.

The consensus statement lists four symptoms that may be early signs of ovarian cancer—bloating, pelvic or abdominal pain, trouble eating or feeling full quickly, and urgent or frequent urination.

Barbara Goff, director of gynaecological oncology at the University of Washington, in Seattle, stressed in a television interview that although these were common symptoms, they were important when they were new to a woman, persisted every day or every other day for more than several weeks, or became progressively more severe.

Dr Goff published an article in JAMA, the journal of the American Medical Association, which said that women with ovarian cancer reported these symptoms before they were diagnosed (2004;291:2705-12). Dr Goff and her coauthors said that women with symptoms that were new or more severe or frequent than expected needed further investigation because they were likely to have benign or malignant ovarian masses.

Debbie Saslow, director of breast and oncological cancer for the American Cancer Society, said, "It has been a longstanding challenge to balance educating women about ovarian cancer symptoms while emphasising that these symptoms are very common, sometimes vague, and usually not related to ovarian cancer.

"There is no standardised guideline for the follow-up of women with symptoms. Many experts would agree that women should be given a thorough bimanual [pelvic and rectal] pelvic examination, transvaginal ultrasound, and a blood test for the tumor marker CA125. Each of these tests alone has a very low level of accuracy for early stage cancer. It is hoped that the combination . . . increases the accuracy."

Women with suspicious findings should be seen by a gynaecological oncologist, the organisations said.

Andrew Berchuck, president of the Society of Gynecologic Oncologists, said that his organisation "has a strong sense that the vast majority of women with ovarian cancer share the concern that their symptoms did not arouse suspicion sooner . . . there is little to be lost and much to be potentially gained by increasing awareness of ovarian cancer symptoms that might lead to earlier medical evaluation and intervention."

Roger Jones, of the department of general practice and primary care at King's College, London, and Guy's, King's College, and St Thomas's Hospitals, said that the guidelines were of limited use. "The symptoms which are more common in women with ovarian cancer are common symptoms anyway and are also symptoms of IBS [irritable bowel syndrome]."

Professor Jones, who was one of the authors of the BMJ paper on alarm symptoms in early diagnosis of cancer in primary care (BMJ 2007;334:1040 doi: 10.1136/bmj.39171.637106.AE), added, "The two telling results in the Goff paper in my view were firstly that the combination of increased abdominal size, bloating, and pelvic pain was seen in 43% of the cancer but only 8% of the non-cancer patients, and, secondly, these symptoms were experienced 20-30 times a year by some of the cancer patients.

"It's a shame that we haven't got predictive values for these symptoms or the beginnings of a scoring system including symptom combinations and symptom frequency. I would be concerned about women feeling that they should seek medical attention for just one of these symptoms alone, particularly if it had only been present for a short time.

"Of course more research with bigger numbers is needed."