7 Clues to Ovarian Cancer

Seven symptoms often reported to doctors are associated with ovarian cancer , according to a new study from the U.K., dispelling the idea that the deadly cancer is a "silent killer" with few clues until the advanced stages.

"Ovarian cancer is not silent, it's noisy," lead author William Hamilton, MD, a consultant senior lecturer at the University of Bristol, tells WebMD in an email interview. "It's just we're not very good at deciphering the noise."

Ovarian cancer accounts for 4% of all cancers in women, Hamilton says, but it has the worst prognosis of all gynecologic cancers. His study is published online in BMJ.com.

Ovarian Cancer Study Details

In the study, Hamilton and his colleagues evaluated 212 women, aged 40 and above, with a diagnosis of primary ovarian cancer and compared them with 1,060 healthy women. The women went to 39 different general practice doctor's offices in Devon, England.

The researchers looked at the medical records for a year before the cancer was diagnosed and did the same for the healthy women. They took note of what symptoms the women had complained about and at what time.

Ovarian Cancer Study Findings

Seven symptoms were found associated with ovarian cancer, including:

•Abdominal distension
•Urinary frequency
•Abdominal pain
•Postmenopausal bleeding
•Loss of appetite
•Rectal bleeding
•Abdominal bloating

The researchers calculated what they term the "positive predictive value" for each symptom -- that is, the chances that a woman with a specific symptom actually does have ovarian cancer.

The symptoms had low positive predictive values -- less than 1% -- except abdominal distension, which had a value of 2.5%.

The 2.5%, Hamilton tells WebMD, means that "one woman in 40 with this symptom will have ovarian cancer." That is a value he considers high, he says.

"It's roughly the same as the risk of lung cancer when you cough blood and the same as colon cancer when you pass blood rectally."

When they evaluated more closely, the researchers found that three of the ovarian cancer symptoms -- abdominal pain, abdominal distension, and urinary frequency -- were reported at least six months before the diagnosis and were significantly associated with ovarian cancer.

Ovarian Cancer Symptoms and Screening

Women often use the term bloating for distension, Hamilton writes. But medical experts generally consider distension as a progressive increase in abdominal size; bloating is an intermittent increase and decrease.

Under current guidelines in the U.K., Hamilton notes in the paper, abdominal distension is not a symptom that warrants "urgent investigation."

In the U.S., bloating is one of the symptoms that is likely to persist in women with ovarian cancer compared to women in the general population, according to the American Cancer Society. If a woman complains of bloating, her doctor will likely do a thorough physical exam , and perhaps a CA-125 blood test, which measures a protein found in the blood of many women with ovarian cancer, or a transvaginal ultrasound .

Routine screening with CA-125 and transvaginal ultrasound isn't done in the general population, according to the ACS, nor is routine screening for ovarian cancer recommended by the American Cancer Society or other medical
organizations. But the tests are often offered to women at high risk of ovarian cancer, such as those with a very strong family history of the disease.

Ovarian Cancer Symptoms: Other Opinions

The study results add to several other studies also finding that ovarian cancer isn't as "silent" as experts thought, says Andrew Li, MD, a gynecologic oncologist at Cedars Sinai Medical Center, Los Angeles. "I think this reinforces wht a lot of other studies have shown, that there are symptoms of ovarian cancer, and that patients and physicians should be aware of them."

Although Hamilton's team found three symptoms to be present more than six months before diagnosis of ovarian cancer, Li says the clinical picture he encounters with his patients is typically different. "Patients are in their
usual state of health and in a three- or four-week period, they develop these symptoms -- mostly the three [pain, distension, and frequency]."

In an editorial accompanying the study, researcher Joan Austoker of the University of Oxford notes that the overall five-year survival rate from
ovarian cancer is poor, about 30% to 40%. That increases to more than 70% for women diagnosed early, she notes, but currently just one-fifth of patients are diagnosed early.

The abdominal distension symptom, she concludes, warrants urgent attention.

Ovarian Cancer Symptoms: Advice

If a woman has abdominal distension, Hamilton suggests asking the doctor for a thorough examination, a transvaginal ultrasound, and a blood test for CA 125.

"The scan is very accurate, but CA 125 somewhat less so, in that the blood test misses some cancers," he says.

An estimated 21,550 women in the U.S. will learn they have ovarian cancer in 2009, according to the American Cancer Society. About 14,600 are expected to die from the disease.

By Kathleen Doheny
Reviewed by Louise Chang
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