WebMD Medical News
Louise Chang, MD
Aug. 25, 2009 -- 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
''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.
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.
Seven symptoms were found associated with ovarian cancer, including:
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.
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.
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 what 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
The abdominal distension symptom, she concludes, warrants urgent
If a woman has abdominal distension, Hamilton suggests asking the doctor for
a thorough examination, a transvaginal ultrasound, and a blood test for CA
"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.
SOURCES:William Hamilton, MD, consultant senior lecturer, University of Bristol,
England.Hamilton, W. BMJ, manuscript received ahead of print.Fox, R. BMJ, manuscript received ahead of print.Austoker, J. BMJ, manuscript received ahead of print.Andrew Li, MD, gynecologic oncologist, Cedars Sinai Medical Center, Los
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