The statement, developed by the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists makes the point that women who have bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urinary symptoms including urgency or frequency should see their doctor (preferably a gynecologist) if the symptoms are new and persistent. (I regret that I can’t find a link to this statement at this time.)
This is a step in the right direction, but we have much further to go if we are to make a significant impact in reducing suffering and death from this disease.
Ovarian cancer is not an uncommon cancer in women.
The American Cancer Society estimates there will be 22,430 new cases diagnosed in the
Unfortunately, ovarian cancer is usually diagnosed after it has spread from its primary site in the ovary. When that happens, the chances for survival decrease considerably.
According to our publication Cancer Facts and Figures 2007, the 5 year survival for all women who present with ovarian cancer is 44.7%. When localized to the ovary, the five year survival is 93.1%. When the cancer has spread to distant sites, the five year survival drops to 29.6%.
The problem is that only 1 in 5 women with ovarian cancer are diagnosed in the early stage.
For years, doctors have been concerned about how to diagnose this disease earlier, when the chances of cure are greatest.
There are some women—in particular, those with a genetic abnormality called BRCA 1 or BRCA 2—who are at higher risk of ovarian (and breast) cancer. These women are candidates for close monitoring for ovarian cancer, and their doctors may recommend that their ovaries be removed after they have completed childbearing.
However, the vast majority of women are not known to be at increased risk of this disease, nor do they have a family history. The cancer occurs sporadically and spontaneously. Frequently, these women are older (the risk of ovarian cancer increases with age, and peaks when women are in their 70’s, according to Cancer Facts and Figures).
There are no effective, generally applicable screening tests for ovarian cancer which would diagnose the disease at an early stage in most women.
Routine pelvic exams are not a good way to find ovarian cancer early. In women at average risk, routine ultrasound exams have not been demonstrated to be an effective screening test, and are not recommended. CA-125, a cancer antigen that is increased in women with ovarian cancer and can be detected through a blood test, may be recommended to screen women at high risk but is not recommended for women at average risk.
So, in the end, there really isn’t much we can do to find this disease early.
Which brings us to today’s statement about the importance of symptoms as something to be considered in helping to make the diagnosis of ovarian cancer.
For years, doctors have known that the symptoms of ovarian cancer can be vague.
Personally, when I practiced primary care internal medicine, this was something that I considered as part of my diagnostic evaluation. However, the odds of any particular patient in my practice with these symptoms having ovarian cancer were remote.
[One aspect worth pointing out is that when you consider the number of primary care physicians and clinicians in the
Over the past several years, there have been several published reports which indicate that women with ovarian cancer—usually on retrospective analysis—do have symptoms that can last for several months or longer before the diagnosis is made.
The problem has been that the symptoms which suggest the possibility of ovarian cancer may be vague, and as a result women may not pay much attention to them and doctors may diminish their significance.
So how do you get patients and clinicians to put ovarian cancer on their list of concerns in a woman with these symptoms?
The process of establishing what we call a differential diagnosis can at times be a complex undertaking, understanding that patients frequently present to their doctors with complaints that don’t exactly point to the underlying problem. We call this “the undifferentiated patient.”
More recently, a research report has suggested that there are certain symptoms that may be more suggestive of ovarian cancer than others. Thus, the list noted at the beginning of this blog.
Given the fact that these symptoms can be vague and common, the consensus statement goes on to emphasize the fact that these symptoms need to be persistent and represent a change from normal for a woman and her body. The statement goes on to say that these symptoms should last daily “for more than a few weeks.”
There is also a list of other symptoms that have been reported in women with ovarian cancer, according to the statement, but which are not more frequent in women with ovarian cancer compared to women who do not have the disease.
These symptoms include: fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities.
So what does all of this discussion really mean?
First, from my perspective, this is a statement that is meant to make women (and their doctors) aware of the fact that seemingly common or relatively minor symptoms such as those noted above could be related to ovarian cancer.
In the busy lives that we lead as patients and as doctors, it is sometimes easy to dismiss something that doesn’t seem important. As patients we put off going to the doctor (most people I know don’t like going to the doctor). And, when we get to see the doctor they may be rushed and not pay much attention to the problem when no cause is obvious.
What this statement does not say is that every woman with these symptoms needs an ultrasound or a CT scan or a CA 125. What they do need is a thorough examination and a plan of follow-up, and consideration by their health care clinician as to what studies should be done, and what to do if the symptoms do not resolve promptly.
The organizations who crafted this statement also say that the evaluation should preferably be done by a gynecologist.
Ovarian cancer is a lethal disease for many women who develop this cancer. However, these symptoms are not uncommon, and I for one will be interested to see how this statement impacts women’s health care.
Will women read this and think that if they have these symptoms that they have ovarian cancer and insist on having tests that may not be medically indicated? Will we be able to truly improve the stage of disease at the time of diagnosis and increase survival as a result of this increased awareness?
The reality is, as noted by one of my valued colleagues in the initial news report this morning , what we really need is a test that will find this disease early and hopefully be available as an effective screening test for all women.
We do not have that test today, but clearly we need it. There is certainly a considerable amount of research currently underway to find just such a test.
That is something that would potentially make a huge impact on this disease.
Until that time, unfortunately, we are left with a less than perfect way of trying to find ovarian cancer early by relying on symptoms that can point in many different diagnostic directions.
Hopefully, by increasing awareness among patients and their clinicians, we will be able to make some progress in improving the outlook of woman with this deadly cancer.