Early cancer detection

Ovarian cancer, long known as the "silent killer" since it was thought to have no symptoms in its earlier, more treatable stages, is not actually so quiet. This is news every woman should hear, loud and clear. A panel of cancer experts and advocacy groups recently identified symptoms they say should serve as early warning signs for ovarian cancer and recommend women who have them longer than two weeks should see their doctor. The goal is to save lives by making sure both women and physicians know signs of the early stages of this deadly disease, since the sooner it is caught the greater likelihood of survival.

I spoke with Barbara Goff, MD, director of gynecologic oncology at the University of Washington School of Medicine and lead author of several studies on ovarian cancer, to ask about what this new information means. Doctors have long considered ovarian cancer to have vague, hard-to-pin-down symptoms, she said. "Just recently we've been able to distinguish the symptoms of early-stage ovarian cancer from seemingly benign symptoms many women experience from time to time," she told me.

WHAT TO WORRY ABOUT...

The experts recommend that women who have the following symptoms daily or almost daily for more than a few weeks should see their doctor -- preferably a gynecologist:

*Bloating or increased abdominal size.
*Pelvic or abdominal pain -- typically below the navel, on one side or the other and made worse with exercise and intercourse.
*Difficulty eating or feeling full quickly.
*Urinary symptoms, including urgency or frequency.

Before you panic, realize this important point -- you don't have to worry about the bloating that typically accompanies your menstrual period or the indigestion you feel after eating a bowl of chili or too much ice cream. "We all have some of these symptoms from time to time," said Dr. Goff. "But, if there is a symptom that is new for you or it persists for more than a couple of weeks, we recommend you go to your doctor. Odds are it won't be cancer... but it is worth having it checked just in case."

WHY THIS NEWS IS SO IMPORTANT

Contrary to the previously held belief that ovarian cancer only makes its presence known when the disease has reached a late and incurable stage, numerous studies have now confirmed that the symptoms listed above are much more likely to occur in women with ovarian cancer than women in the general population. Researchers finally have enough statistically significant studies that can distinguish the symptoms of ovarian cancer from day-to-day symptoms. "We now have an evidenced-based statement that these symptoms are predictive of ovarian cancer," said Dr. Goff, who is a spokesperson for the Gynecologic Cancer Foundation.

Dr. Goff and her colleagues hope that earlier diagnosis will save more lives from this lethal disease. The American Cancer Society estimates there will be 22,000 new cases of ovarian cancer and 15,000 deaths from the disease this year, making it the most deadly female reproductive system cancer and the fifth most common cause of cancer death in women. Overall, about three-quarters of women with ovarian
cancer survive one year after they are diagnosed, and nearly half (45%) survive longer than five years after diagnosis. But that figure soars to 93% when ovarian cancer is diagnosed and treated before it has spread outside of the ovary -- though unfortunately, historically it has usually been diagnosed after that point, in which case the chances for survival decrease considerably.

There's no screening test available at present for ovarian cancer, making awareness of symptoms all the more important. The risk factors for ovarian cancer include a personal and/or family history (mother, sister or daughter) of ovarian cancer or cancer of the breast, uterus, colon, or rectum... age over 55... never being pregnant... and taking estrogen alone (not with progesterone) for menopausal hormone therapy. A woman's lifetime chance of developing ovarian and/or breast cancer is greatly increased if she inherits an altered BRCA1 or BRCA2 gene (short for breast cancer one and two). This genetic abnormality can be identified through a genetic screening blood test.

MISDIAGNOSIS HAS BEEN A MAJOR PROBLEM

That the symptoms are so non-specific has meant that many women with early ovarian cancer are told there's nothing wrong or are given wrong diagnoses. "Misdiagnosis of ovarian cancer is common," said Dr. Goff. "One study conducted in 2000 showed that a significant percentage of ovarian cancer patients were wrongly diagnosed with other conditions prior to their diagnosis of ovarian cancer." She said that 12% had been told they had irritable bowel syndrome... 12% were told it was stress... 10% were told nothing was wrong... and 6% were diagnosed with depression. Thirty percent of these women were treated with medication for other diseases -- and all subsequently went on to learn that it was, in fact, ovarian cancer that was causing their symptoms.

WHAT EVERY WOMAN NEEDS TO KNOW

*If you have persistent symptoms, see your doctor. If, for no particular reason, you feel pain in your abdomen, experience bloating or find you are feeling full after eating only a bit, and especially if these symptoms last longer than a couple of weeks, see your doctor -- soon.

He/she will conduct a pelvic and rectal exam and, depending on the results, may order additional tests such as a transvaginal ultrasound or a CA125 blood test, which measures the elevation of an ovarian tumor marker.

*Don't be afraid to get a second opinion. If you feel your doctor hasn't taken you seriously or you aren't confident in the opinion or diagnosis, seek a second opinion, Dr. Goff urges. "People are so worried about insulting their doctor. It's no different than getting a job done in your house. You'd get more than one bid, wouldn't you?"

*If diagnosed with ovarian cancer, seek care from a gynecologic oncologist. Cure rates among women with ovarian cancer are much higher if they are cared for by a gynecologic oncologist (a surgeon who has trained extensively in treating female reproductive cancers), says Dr. Goff.

*Spread awareness, it's critical. Right now, because there is no screening test, awareness of the symptoms of ovarian cancer remains our first and best opportunity to fight this deadly disease.

Source - Barbara A. Goff, MD, is professor and director of
gynecologic oncology and adjunct professor of surgery at
the University of Washington School of Medicine in Seattle.
Her research interests include ovarian cancer and early
detection, complex gynecologic oncology surgery, and
clinical trials for gynecologic malignancies. Dr. Goff is
coauthor of "Development of an ovarian cancer symptom
index," which was published in the January 15, 2007, issue
of the journal Cancer.

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