Researchers from the UK have reported that women with ovarian cancer usually report symptoms to primary care physicians before the diagnosis. These researchers suggest that these symptoms should be included in guidelines for diagnostic testing. The details of this study appeared online in the British Medical Journal on August 25, 2009.[1]

Ovarian cancer has the highest mortality rate of all gynecologic cancers. It is the fifth leading cause of cancer death among U.S. women, with a projected 21,650 new cases and 15,520 deaths in the year 2008.

One of the reasons that ovarian cancer tends to be so deadly is that it is often detected at a late stage when it is difficult to treat. An important focus of research, therefore, is the development of effective screening tests that will allow for the earlier detection of ovarian cancer. Currently, screening by CA125 testing and annually sonography have received the most interest. However, there are no very effective tests for early detection, and physicians have to rely on symptoms for early diagnosis. Researchers from the University of Washington have previously reported that women with ovarian cancer often have “more severe or frequent symptoms than expected”—which warrants further diagnostic testing when symptoms occur. These researchers found that women with ovarian cancer reported more complaints of increased abdominal size, bloating, urinary urgency, and pelvic pain.  Furthermore, women with malignant masses typically experienced symptoms 20-30 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% of those with cancer but only 8% of those presenting to primary care clinics.

Researchers in the Department of Community Based Medicine in Bristol in the UK attempted to determine what symptoms were present in 212 women with primary ovarian cancer prior to their diagnosis. They found the following symptoms to be the most significant compared with control patients without ovarian cancer:

• Abdominal distention
• Postmenopausal bleeding
• Loss of appetite
• Increased urinary frequency
• Abdominal pain
• Rectal bleeding
• Abdominal bloating

They reported that 85% of women in this study reported at least one of these seven symptoms to their primary care physician. When symptoms occurring within six months of diagnosis were excluded, the significant early symptoms were: abdominal distention, urinary frequency, and abdominal pain. These authors concluded: “Women with ovarian cancer usually have symptoms and report them to primary care, sometimes months before diagnosis.”

Comments: This study is consistent with the previous U.S. study suggesting that women with ovarian cancer have early symptoms that should alert primary care physicians to perform screening CA125 and referral for ultrasonography examination of the ovaries.

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