A "silent" cancer speaks with 4 symptoms

A cluster of new and frequently occurring symptoms should alert physicians and patients to the need for further evaluation for ovarian cancer.

By — Posted July 9, 2007

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Ovarian cancer, long known as a "silent killer," actually announces its presence. Although it does so quietly, several cancer groups would like physicians and their patients to listen carefully.

Recent research identified four early symptoms of this disease, which is notoriously hard to detect at an early enough stage to allow for successful treatment.

Likely to be diagnosed in more than 22,000 women in the United States this year, the cancer also will kill more than 15,000, according to the American Cancer Society.

A June 13 consensus statement by the American Cancer Society, the Society of Gynecologic Oncologists and the Gynecologic Cancer Foundation indicates that the presence of a cluster of symptoms can serve as an early warning sign for this cancer, which begins deep within the pelvis.

The symptoms are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and a frequent or urgent need to urinate. Although they are seemingly common complaints, the symptoms shouldn't be ignored, especially if they are new, occur daily and persist for at least a few weeks.

The consensus statement is intended to increase awareness of these early markers, said Len Lichtenfeld, MD, deputy chief medical officer at the national office of the American Cancer Society in Atlanta.

The long-held belief that this cancer did not send signals was a "disservice to women," said Carolyn Muller, MD, associate professor of obstetrics and gynecology at the University of New Mexico, Albuquerque. She also chairs the marketing and communications committee of the Society of Gynecologic Oncologists.

Many women with advanced cancer said they reported symptoms, which are now identified as early warning indicators, to their physicians months before their cancers were diagnosed. This shouldn't happen again, Dr. Muller said.

"If the symptoms come up, then the thought of ovarian cancer should come up," she said. "If you don't even know to think about it, it will never even make the differential diagnosis."

Sorting through the signs

But because these same symptoms are very common, it's also a given that ovarian cancer will be found in only a few of the patients who report them, Dr. Lichtenfeld said.

The authors of the statement, however, thought it was better to err on the side of caution for this disease. Although 93% of women diagnosed with early stage ovarian cancer will survive for five years or longer, and most will be cured, only 19% of the cancers are found soon enough.

After the cancer has spread to distant sites, the five-year survival rate drops to about 30%, Dr. Lichtenfeld said. Early diagnosis is crucial in successfully treating this cancer.

Although the statement doesn't say what to do if the symptoms are present, it does recommend a referral to a gynecologic oncologist.

Dr. Muller suggested a thorough assessment that includes age and family history. Women with BRCA 1 or BRCA 2 mutations are at higher risk for both breast and ovarian cancer than those without those genes.

She also recommended a comprehensive exam of the pelvis and a rectal and vaginal exam to look for additional, although still subtle, changes that could be symptoms. Tests, including transvaginal ultrasound and CA-125, can be performed. But both can produce false positive results.

"The dilemma is, of course, what happens if the ultrasound shows a complex mass that could be ovarian cancer?" Dr. Lichtenfeld noted. "Or the ultrasound is normal, and the CA-125 is elevated. Then what do you do?"

In those cases, perhaps an evaluation of the ovaries is in order. "All of that must remain in the clinical judgment of the physician in discussion with the patient," he said.

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