Ovarian cancer is the most common and harmful type of gynecologic cancer. It can affect women of any age; however, it is generally diagnosed after menopause. The greatest risk factors for ovarian cancer are having a family history of ovarian and breast cancer (inherited genes), as well as age (most common in women of ages 50-60).
Every year, more than 20,000 women in the United States are diagnosed with ovarian cancer and over 75% of the affected women are diagnosed at a late stage (stage 3 or stage 4). This is because early stage ovarian cancer (stage 1) is asymptomatic, meaning that the cancer does not present any specific symptoms, therefore making it difficult to detect.
Exact individual symptoms
A recent study sought to identify the exact individual symptoms and groupings of symptoms for the diagnosis of ovarian cancer. The bibliographic database, Medline, was searched through - reviewing 71 articles and 2,492 abstracts. Eventually, 17 studies published 2001-2014 that met the criterion were found. Heterogeneity effects, threshold effects, and bivariate random effects were explored and the data gathered. QUADAS-2 criteria was used to evaluate the study’s main objective. The data revealed that most of the 17 studies were at high risk of bias, particularly due to their case-control outline or different verification outline.
The most common symptoms revealed by the study
The symptoms associated with a diagnosis of ovarian cancer that revealed the highest levels of positivity included: decreased appetite, abdominal or pelvic bloating, abdominal or pelvic pain, presence of a mass in the stomach, increased abdominal girth or distension, and a family history of ovarian cancer. However, none of the symptoms proved useful in excluding ovarian cancer in light of their absence.
The Ovarian Cancer Symptom Index was confirmed in 5 of the studies and results revealed 95% specificity and 63% sensitivity. While several individual signs and symptoms of ovarian cancer showed a significant increase in the likelihood of the presence of ovarian cancer, more research needs to be conducted in order to confirm the results. Moreover, more research is needed to develop new decision support tools for positivity identifying ovarian cancer risk through signs, symptoms, risk factors, and biomarkers.
The trouble with misdiagnosis
Before being diagnosed with stage 1 ovarian cancer at the age of 44, Pam Faerber began experiencing bloating and pain in her stomach, as well as pain in her back. “Like so many of us women do, I started talking about it to my hairdresser” she said. After going to see an internist as her hairdresser had advised her to do, the doctor said that she was most likely going through menopause. Now, a survivor of 14 years, she wishes she had asked for a second opinion. “I knew something was wrong with my body, but I was not proactive” she said. Pam never considered that ovarian cancer was the cause of her pain. “It’s so soundly engrained in the medical field—and among women—as the silent killer” she said.
New research shows that once being diagnosed with late stage ovarian cancer, a woman has a 20-30% chance of a five-year survival rate. On the other hand, being able to recognize the signs and symptoms of ovarian cancer could indicate a 90% survival rate. “We need a cure and we need better screening tests. In the interim, we need to get the facts straight about symptoms so we can quit finding these women in such late stages” said Faerber.
Studies reveal symptoms not to be as silent as once thought
A few studies conducted by Barbara A. Goff, a gynecologic oncologist from the University of Washington, revealed a pattern: “What we found was ovarian cancer wasn’t silent. Ninety-five percent of women have symptoms” said Dr. Goff. The symptoms included abdominal or pelvic pain, bloating, loss of appetite, feeling full too quickly, feeling an urgent need to urinate, or urinating more often. “You’ll notice we didn’t include fatigue in the statement because although a lot of survivors have fatigue, it’s still not predictive of having ovarian cancer” she said. The symptoms of ovarian cancer can be quite vague and similar to those of other common medical conditions. For this reason, ovarian cancer tests are offered to women who experience 2-3 weeks of such persistent symptoms. While these symptoms are the most common ones found in women with ovarian cancer, they do not necessarily indicate the presence of ovarian cancer. It is merely important to be aware of patterns, meaning being able to recognize if the symptoms start unexpectedly, if they feel different from digestive or menstrual problems, or if they occur on a daily basis. Due to the fact that there are no proper screening tests for ovarian cancer, Dr. Goff hopes that by reviewing the symptoms, diagnosis of ovarian cancer can be made earlier on. “Most people who have these symptoms are not going to have ovarian cancer, just like most breast lumps are benign. But it’s important to take them seriously and work them up” said Dr. Goff.
“It raises the level of consciousness and encourages women to at least ask about the possibility of ovarian cancer. Will it save lives? That remains to be proven” said Beth Karlan, director of the Women’s Cancer Research Institute and the Gilda Radner Hereditary Cancer Detection Program at Cedars-Sinai Medical Center in Los Angeles. “It’s going to be challenging because every primary care physician sees a large number of people who have common symptoms, such as belly pain. There’s hope this research and the guideline will improve our ability to pick out that one woman who has ovarian cancer from the larger group” said Dr. Richard Wender, chairman of the Department of Family and Community Medicine at Thomas Jefferson University Hospital in Philadelphia.
There is room for more research
Over the last few years, research has focused on symptoms of ovarian cancer experienced prior to the diagnosis of the cancer. However, the results of the research have not been able to identify any prognostic symptoms because of the nature of the studies themselves. Some of the studies have taken too long between the period of diagnosis and data gathered – with extended periods, results are less reliable. Several studies have also solely relied on symptoms recorded in patients’ medical records, thereby unlikely to reveal duration and severity of the symptoms. Additionally, more recent studies have sought to systematically record symptoms experienced prior to diagnosis of ovarian cancer; however, data collection techniques have proved to be invalidated. While data collection techniques, such as symptom checklists, have been created based on existing medical literature, they do not include specific events. It is the unrecorded specific events that are the main cause for the diagnostic dilemma questioning the difference between early stage and late stage ovarian cancer. As a result, the lack of definitive and accurate results has limited ovarian cancer research to date.
Until new screenings tests and better tools come along, the shift has to be made toward appropriate and open communication between the doctor and the patient. “Although we do need an adequate screening test, I think we are years, if not decades, away from having that test. But there is a possibility of making the diagnosis earlier by having women identify these symptoms and having doctors take these symptoms seriously” said Dr. Goff.