Experts from several US cancer organizations have agreed on a national list of symptoms that could help the detection of early stage ovarian cancer.

Ovarian cancer is often called the "silent killer" because in most cases it is only detected after it has spread beyond the ovaries. And until now there has been a commonly held view that there are no early warning signs.

Ovarian cancer is the deadliest of the gynecological cancers with 22,000 new cases and 15,000 deaths in the US expected this year. About 80 per cent of ovarian cancer cases are not detected early, resulting in a poor survival chance.

The National Ovarian Cancer Coalition (NOCC), the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society have announced the first national agreement on ovarian cancer symptoms.

Based on research led by Dr Barbara Goff, a gynecologic oncologist at the University of Washington, who has published several papers in recent years, the symptoms that are much more likely to be experienced by women with ovarian cancer compared to the general population are: Bloating. Pelvic or abdominal pain. Difficulty eating or feeling full quickly. Urinary symptoms (urgency or frequency). Women experiencing these symptoms daily for several weeks should see their doctor, preferably a gynecologist, said the joint announcement.

According to Goff women with these symptoms should have a full physical and gynecological exam that includes examination of the pelvis and rectum. If these show up any abnormalities then an ultrasound exam should follow, to look for ovarian masses. Blood tests and other procedures may also be needed, depending on what the ultrasound shows.

Even if the ultrasound is clear, doctors should consider other tests, such as colonoscopy or CAT scans, to find out what is causing the symptoms, said Goff.

April Donahue, president of the NOCC said her organization had launched a nationwide campaign called "Break the Silence" to raise women's awareness about the symptoms of ovarian cancer, and to "encourage them to pay attention to their bodies and proactively engage in discussions with their physicians".

Goff said that:

"This agreement on common symptoms of ovarian cancer hopefully will lead to earlier diagnosis when a cure is more likely."

"We know that when women are diagnosed in Stage I of the disease, it is 90 per cent curable. Unfortunately, until now there has been no agreement on common symptoms, allowing women to go undiagnosed, despite visits to the doctor, until it was too late."

And chief executive officer of the NOCC Jane Langridge explained that:

"Because there is no screening tool, it is crucial that the medical community has come to a formal consensus that symptoms of ovarian cancer exist and the appropriate action needs to be taken immediately when women discuss them with physicians."

"Ovarian cancer is taking far too many lives and we hope these findings jumpstart public dialogue and awareness to ultimately improve survival rates," she added.

Writing in the journal Cancer last year, Goff and colleagues said that women who have these early symptoms should be thoroughly checked for ovarian cancer. Obviously not all women who have these symptoms will have ovarian cancer. The disease accounts for only 3 per cent of cancers in women, and the symptoms could be due to other more common conditions such as irritable bowel syndrome.

But Goff said women need to know when to take the symptoms seriously and doctors need to know when to look for ovarian cancer. Many women have these symptoms from time to time, but if they persist for several weeks on a daily basis, that is when a woman should go to the doctor, she said, even though it will probably turn out not to be ovarian cancer.

Writing on their web page for ovarian cancer, Dr Debbie Saslow, director of breast and gynecologic cancers at the American Cancer Society agrees.

"Doctors should first rule out more common causes for these symptoms. But once they've done that, they should look for ovarian cancer; not let the woman go."

"It's not the first thing you'd look for, but it should be one of the things," she adds.

Goff and her team questioned women with and without ovarian cancer about 23 symptoms that had been previously studied in connection with the disease. Other symptoms on the list included indigestion, constipation, bleeding after menopause, and back pain.

They found that women with ovarian cancer were more likely to say they had one or more of the 6 symptoms on the overall list and were typically experiencing them 12 times or more in a month. Also they had developed the symptoms relatively recently, within the last 12 months.

There is no reliable routine screening test for ovarian cancer, and until then, women and their doctors could use this list as a starting point to work out what further action to take to look for ovarian cancer, they said.

Click here for National Ovarian Cancer Coalition (NOCC).

Click here for American Cancer Society web pages on Ovarian Cancer.

"Development of an ovarian cancer symptom index: possibilities for earlier detection."
Barbara A. Goff, Lynn S. Mandel, Charles W. Drescher, Nicole Urban, Shirley Gough, Kristi M. Schurman, Joshua Patras, Barry S. Mahony, and M. Robyn Andersen.
Cancer Volume 109, Issue 2, Pages 221 - 227.
Published Online: 11 Dec 2006
doi 10.1002/cncr.22371

Click here for Abstract.

: Catharine Paddock
Writer: blog