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Am Fam Physician. 2005;71(6):1196-1199

Although ovarian cancer has been thought to be asymptomatic until the late stages of the disease, recent studies have indicated that women with ovarian cancer reported symptoms before diagnosis, and these symptoms are similar for late and early disease stages. The most common complaints reported before diagnosis have included abdominal, gastrointestinal tract, pain, constitutional, urinary, and pelvic symtoms. Given that five-year survival for ovarian cancer is much higher with early diagnosis, a reliable set of symptoms to look for might facilitate early detection. Goff and colleagues performed a study of primary care patients to determine whether the frequency, severity, and duration of symptoms were more pronounced in women with ovarian cancer than in those seen for routine problems.

The authors surveyed women visiting two primary care sites regarding the severity, frequency, and duration of 20 symptoms associated with ovarian cancer. The same survey was given to women presenting at a specialty clinic for removal of an ovarian or pelvic mass.

Of the 1,709 patients who completed the survey, 25 percent were presenting for a general checkup, 13 percent were there for a mammogram, and 62 percent were being seen for specific problems. Of these women, 95 percent had at least one of the 20 listed symptoms in the previous year, with back pain reported most commonly (60 percent), then fatigue (52 percent), indigestion (37 percent), urinary tract symptoms (35 percent), constipation (33 percent), and abdominal pain (28 percent). Many of the symptoms recurred at least monthly in 72 percent of the women. Symptoms were most common in women with diabetes, thyroid disease, and irritable bowel syndrome (IBS). Post-menopausal women had fewer symptoms overall than premenopausal women. As age increased, all symptoms were less common except for urinary tract symptoms.

Of the 128 women with a pelvic mass, 84 had benign masses and 44 had malignancies, 11 with early stage disease and 33 with advanced disease. Women with malignancies had a higher median number of symptoms and recurring symptoms than the clinic patients, with 36 percent having had symptoms for two months or less, 24 percent having symptoms for two to three months, and 14 percent having symptoms longer than one year. When comparing women who had malignancy with women who had IBS (and, therefore, had high numbers of symptoms), a significantly higher percentage of women with malignancy had pelvic pain (41 versus 25 percent), bloating (70 versus 49 percent), increased abdominal size (64 versus 32 percent), and urinary tract symptoms (55 versus 33 percent). Women with ovarian cancer were significantly more likely than the clinic group to have pelvic pain, abdominal pain, difficulty eating, bloating, increased abdominal size, and urinary urgency.

In comparing groups of symptoms, 43 percent of women with ovarian cancer had the combination of bloating, abdominal pain, and urinary tract symptoms, whereas 10 percent of women with benign masses, 13 percent of women with IBS, and 8 percent of clinic women had this combination. Symptoms were more severe and more frequent in women with ovarian cancer or IBS than in clinic patients. Symptoms typically were continuous in women with malignancies, compared with occasional and intermittent symptoms in clinic patients. Women with benign masses also often had daily symptoms, which overlapped with the symptoms experienced by women with ovarian cancer, but included constipation. Finally, women with ovarian cancer had a much shorter duration of symptoms at a median of six months or less compared with 12 to 24 months in clinic patients and those with IBS.

No effective screening test exists for ovarian cancer. The symptoms most commonly reported in patients with ovarian cancer include bloating, increased abdominal size, abdominal or pelvic pain, and urinary tract symptoms, although these also are common in women with benign masses. Symptoms tend to be more severe, more frequent, and of shorter duration in women with malignant masses than in women with benign masses. Women with ovarian cancer also are more likely to present with a combination of symptoms.

The authors conclude that this study provides more evidence that ovarian cancer is not an asymptomatic disease. Symptoms that are more severe, more frequent, and of recent onset are more likely to be associated with ovarian masses.

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Copyright © 2005 by the American Academy of Family Physicians.

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