Warning Symptoms of Ovarian Cancer

September is Cancer Awareness Month

Ovarian cancer has been called the “silent killer”, although that term has been denied by several reports in the last decade. What it meant, originally, was that there are often no specific symptoms until the tumor has advanced to a degree that it is beyond the reach of successful treatment. In an effort to refute the “silent” soubriquet, UK physicians have done an analysis that tackles the problem, and have the tumor to be “noisy” - but it’s a quite confusing noise.

A report of the study is in the British Medical Journal. The investigators were 39 family physicians in Devon, England. 212 women over 40 with ovarian cancer diagnosed between 2007 and 2009 were compared with 1,060 healthy women, who were matched by age and doctor’s office. The positive predictive value – the chances that a woman with the specific symptom actually has ovarian cancer -  for symptoms reported in the year leading up to diagnosis were obtained from the patients’ medical records.

Seven symptoms were found to be associated with ovarian cancer; one or more were reported in 85% of cases compared with 15% of healthy controls. They were:

Abdominal distension

Urinary frequency

Abdominal pain

Postmenopausal bleeding

Loss of appetite

Rectal bleeding

Abdominal bloating

All these symptoms had a low predictive value – less than 1% - except for abdominal distension, which had a 2.5% value. This means that one woman in 40 who complain of abdominal distension is likely to have ovarian cancer. This predictive value is roughly the same as that for coughing blood and lung cancer, or rectal bleeding with colon cancer.

Closer analysis of the findings showed that 3 symptoms – abdominal pain, abdominal distension, and urinary frequency – were reported at least 6 months before the diagnosis and were significantly associated with ovarian cancer.

What’s the difference between distension and bloating? Distension is generally considered as a progressive increase in abdominal size, whereas bloating in an intermittent increase and decrease.

The practical consequences are obvious. The prognosis of ovarian cancer is so poor that any way to get a jump on the diagnosis is to be encouraged. Women who complain of abdominal pain, distension or bloating, and urinary frequency should have a CA-125 blood test or a transvaginal ultrasound exam.