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Early Symptoms of Ovarian Cancer

Abdominal pain and swelling, pelvic pain, and GI symptoms appear to be much more common in women with ovarian cancer than in others, with onset many months before diagnosis.

These investigators sought to determine the prevalence and timing of symptoms that precede ovarian cancer diagnosis. Using Medicare claims data linked to the National Cancer Institute’s Surveillance, Epidemiology, and End Results database for California, they retrospectively evaluated symptoms in 1985 women (age, 68) with stage IC or higher ovarian cancer diagnosed from 1994 through 1999 (cases), 6024 age-matched female Medicare participants without cancer (controls), and 10,941 older women with localized breast cancer (controls). Target symptom categories were chosen for analysis on the basis of symptoms reported in earlier studies.

Abdominal pain was recorded significantly more often in cases than in controls within 9 months before diagnosis; pelvic pain and abdominal swelling, within 6 months; and gastrointestinal symptoms, within 3 months. These symptoms reached peak prevalence in the 3 months before diagnosis: abdominal pain, 31% of cases (odds ratio vs. either control group, 6); pelvic pain, 5% (OR, 4); abdominal swelling, 17% (OR, >30); and GI symptoms, 8% (OR, 2). Differences in two other target symptom categories — fatigue/malaise and urinary symptoms — were minimal between cases and controls.

Comment: Unfortunately, appropriate screening strategies are not available for ovarian cancer. Nonetheless, consistent with previous findings (Journal Watch Women’s Health Aug 24 2004), these results demonstrate that certain target symptoms are much more likely to occur in women with ovarian cancer than in other women, with onset many months before diagnosis. Given that symptoms were documented before cancer diagnosis, this study avoided the recall bias that can lead to overestimation of symptom prevalence. Clinicians should be proactive about ordering pelvic imaging when postmenopausal patients present with unexplained symptoms such as vague GI, abdominal, and pelvic complaints. In this setting, pelvic ultrasound likely is more cost-effective than computed tomography or magnetic resonance imaging.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health October 18, 2005

Citation(s):

Smith LH et al. Ovarian cancer: Can we make the clinical diagnosis earlier? Cancer 2005 Oct 1; 104:1398-407.

• Medline abstract (Free)