A cluster of early symptoms may help pinpoint ovarian Ca

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Contrary to conventional wisdom, ovarian cancer may often be preceded by a cluster of symptoms, according to a recent prospective, case–control study. Researchers have found that women with ovarian masses found at surgery to be malignant tend to report symptoms—albeit broad and sometimes indistinct—of greater severity, greater frequency, and of more recent onset than women with benign masses or other conditions.

Of the women in the study with ovarian cancer, 94% had symptoms—most commonly bloating, increased abdominal size, fatigue, urinary tract symptoms, and pelvic or abdominal pain—in the prior year and 67% had recurring symptoms. Women with malignant masses typically experienced symptoms 20 to 30 times per month. Symptoms such as abdominal or pelvic pain, bloating, constipation, and increased abdominal size, which often point toward irritable bowel syndrome (IBS), were found to be significantly more severe among the women with ovarian cancer than among those found to have IBS.

Researchers also found that such symptoms usually plagued patients with ovarian cancer for about 3 to 6 months prior to a diagnosis, while those with IBS suffered with the symptoms for 1 to 2 years.

The combination of bloating, increased abdominal size, and urinary symptoms was particularly telling, occurring in 43% of the women with cancer and in only 8% of those presenting to primary care clinics.

The authors noted that as cancer patients aged, almost all such symptoms became less frequent and less severe, underscoring the importance of not attributing symptoms associated with ovarian cancer to the aging process.

Goff BA, Mandel LS, Melancon CH, et al. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004;291:2705-2712 and Daly MB, Ozols RF. Symptoms of ovarian cancer—where to set the bar? JAMA. 2004;291:2755-2756.

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raanan meyer, md
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