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Specific Symptoms May Assist in Early Detection of Ovarian Cancer

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Charles Vega, MD, FAAFP
  • CME / CE Released: 12/12/2006; Reviewed and Renewed: 12/12/2007
  • Valid for credit through: 12/12/2008
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This article is intended for primary care clinicians, obstetrician-gynecologists, and other specialists who care for women at risk for ovarian cancer.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Describe the epidemiology and prognosis of ovarian cancer.
  • List symptoms that are most predictive of ovarian cancer.


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  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P Vega, MD

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.

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Specific Symptoms May Assist in Early Detection of Ovarian Cancer

Authors: News Author: Laurie Barclay, MD CME Author: Charles Vega, MD, FAAFPFaculty and Disclosures

CME / CE Released: 12/12/2006; Reviewed and Renewed: 12/12/2007

Valid for credit through: 12/12/2008


December 12, 2006 — Early detection of ovarian cancer is possible through an evaluation of specific symptoms of recent onset and significant frequency, according to the results of a case-control study reported in the December 11 Early View issue of Cancer.

"Currently, screening for ovarian cancer is not recommended for the general population," write Barbara A. Goff, MD, of the University of Washington School of Medicine in Seattle, and colleagues. "Targeting women with specific symptoms for screening has been evaluated only recently, because it was believed that symptoms had limited specificity."

In this case-control study, 149 women with ovarian cancer, 255 women who were in a screening program, and 233 women who were referred for pelvic/abdominal ultrasound completed a survey of symptoms. Patients were randomized to an exploratory group or a confirmatory group, and symptom types, frequency, severity, and duration were compared between cases and controls. Using logistic regression, the investigators determined which factors independently predicted cancer in the exploratory group. These factors were then used to develop a symptom index, which was tested in the confirmatory group for sensitivity and specificity.

Symptoms that were associated significantly with ovarian cancer, when present for less than 1 year but occurring more than 12 days per month, were pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating/feeling full. Logistic regression analysis revealed that symptoms that were associated independently with cancer were pelvic/abdominal pain (P < .001), increased abdominal size/bloating (P < .001), and difficulty eating/feeling full (P = .010).

A symptom index was considered positive if any of those 6 symptoms occurred more than 12 times per month but were present for less than 1 year. In the confirmatory sample, the symptom index was 56.7% sensitive for early-stage disease and 79.5% sensitive for advanced-stage disease. Specificity was 90% for women older than 50 years and 86.7% for women younger than 50 years.

Study limitations include possible recall bias.

"Specific symptoms in conjunction with their frequency and duration were useful in identifying women with ovarian cancer," the authors write. "A symptom index may be useful for identifying women who are at risk.... The current results suggest that women who complain of abdominal/pelvic pain, increased abdominal size/bloating, or difficulty eating/feeling full quickly that is of < 12 months' duration and occurs > 12 times per month should be evaluated for potential ovarian cancer."

The Marsha Rivkin Center for Ovarian Cancer Research (Seattle, Washington) and the National Institutes of Health/National Cancer Institute supported this study.

In an accompanying editorial, Sherry Salway Black, MBA, of the Ovarian Cancer National Alliance in Washington, DC, and colleagues note that recognition by the medical community of early-stage symptoms is relatively recent.

"The ultimate victory for survivors will be the identification of specific biomarkers for ovarian cancer that will enable development of a screening test," Ms. Black and colleagues write. "The symptom index has the potential to be a valuable tool — further research will determine to what extent.... Currently, awareness of these symptoms is our best hope for early detection."

Cancer. Published online December 11, 2006.

Clinical Context

Ovarian cancer will be diagnosed in approximately 21,000 women this year in the United States, making it the second most common gynecologic cancer. More than 70% of women are diagnosed at an advanced stage of the disease, which contributes to an average 5-year survival rate of only 20% to 30%. However, cure rates can be as high as 90% when patients receive treatment while the cancer is confined to the ovary.

Conventional medical wisdom dictates that symptoms of ovarian cancer may not present until the tumor has advanced past the early stages of growth. The authors of the current study examine whether certain symptoms might help suggest a diagnosis of ovarian cancer early in the disease process.

Study Highlights

  • Study participants were drawn from 1 of 3 groups: women undergoing surgery for pelvic masses, women presenting for pelvic ultrasound, and women participating in a screening study for ovarian cancer. Women completed a survey inquiring into the presence of 23 symptoms before they were aware of their diagnoses.
  • The main study outcome was a case-control comparison examining the presence of symptoms associated with ovarian cancer. This result was adjusted for the presence of depressive symptoms and age. The authors performed a regression analysis to determine the significance of symptoms related to ovarian cancer, and they also examined a group of significant symptoms for sensitivity and specificity in predicting ovarian cancer.
  • 149 women with ovarian cancer were compared with 458 controls. Among women with ovarian cancer, 55 had early-stage disease, 88 had late-stage disease, and 6 had an unknown stage of disease. Women with ovarian cancer were significantly older and had more symptoms compared with controls.
  • Pelvic and abdominal pain, urinary urgency and frequency, increased abdominal size and bloating, and early satiety were symptoms significantly associated with cases more often than controls.
  • The authors created a screening model for ovarian cancer that questioned the presence of pelvic and abdominal pain, increased abdominal size and bloating, and early satiety for less than 12 months. In this model, symptoms occurred more than 12 times per month. This model achieved a sensitivity and specificity of 66.7% and 90%, respectively, for detecting ovarian cancer among women older than 50 years. The respective sensitivity and specificity for women younger than 50 years were both 86.7%.
  • The sensitivity of the screening model for early-stage ovarian cancer was 56.7%, and the sensitivity increased to 79.5% when specifically examining late-stage cancer.
  • Applying the screening model to a study of a general population of women who previously completed the symptom questionnaire in a primary care clinic, the rate of at least 1 symptom present for less than 1 year and occurring more than 12 times per month was 2.6%. Rates of a positive screen result were 3.3% among women younger than 50 years old, and 1.4% among women at age 50 years or older.

Pearls for Practice

  • Ovarian cancer is the second most common gynecologic malignancy and is associated with 5-year survival rates between 20% and 30%. However, cure rates can be as high as 90% if the tumor is discovered in its earliest stages.
  • The current study found that pelvic and abdominal pain, increased abdominal size and bloating, and early satiety were symptomatic markers of ovarian cancer. When these symptoms are present for less than 12 months and occur more often than 12 times per month, they carry a specificity of up to 90% in the detection of ovarian cancer.


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