Finding Ovarian Cancer Earlier Critical

It might be possible to diagnose ovarian cancer earlier by tweaking the schedule of tests that help diagnose the disease, new research shows.

But first, women can take charge by seeing their doctor for symptoms that would increase their suspicion of ovarian cancer and following up if those symptoms don't go away, even if tests don't immediately note ovarian cancer.

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About Ovarian Cancer

Ovarian cancer is the No. 4 cause of cancer death in U.S. women, according to the American Cancer Society (ACS).

Ovarian cancer rates have been dropping since 1991, but the disease remains the seventh most common cancer among American women (not counting skin cancer), states the ACS' web site.

Ovarian cancer often doesn't reveal itself right away; it is often called a silent cancer. However, many women with this cancer do report symptoms months earlier even with early-stage cancer.

Unfortunately, it's estimated that 75 percent to 80 percent of cases are diagnosed at an advanced stage.

Persistent symptoms can include:

—Discomfort or cramping in the stomach or abdomen

—Pelvic pressure or discomfort in the lower back

—Gastrointestinal problems (such as persistent bloating or intestinal gas that isn't relieved by home treatments)

—Abnormal vaginal bleeding

—Change in bowel or bladder habits

—Nausea, lack of appetite, drop in energy level

Those symptoms could have nothing to do with ovarian cancer, but they may be worth checking out.

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Researcher's Advice

"Women with symptoms should go their doctor for routine medical evaluation," professor Lloyd Smith, MD, PhD, tells WebMD in an email. He leads the obstetrics and gynecology department at the University of California, Davis Health System.

"The vast majority of such symptoms will be found to be from other causes, not ovarian cancer," Smith continues.

"However, if routine medical evaluation fails to reveal the cause and if the symptoms persist, patients and their doctors should think about tests which could lead to a diagnosis of ovarian cancer (e.g., pelvic imaging)," he writes in the email.

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Tracking Symptoms of Ovarian Cancer

Smith and colleagues recently studied medical records of more than 18,000 elderly women in the Medicare system. Nearly 2,000 of the women had ovarian cancer.

Smith's team checked the women's medical records before the diagnosis. The findings:

—Women with ovarian cancer were more than twice as likely to see a doctor for abdominal swelling in the 10-12 months before their ovarian cancer diagnosis.

—Women with ovarian cancer were also more likely to see a doctor about abdominal pain, abdominal swelling, gastrointestinal symptoms, and pelvic pain in the 1 to 3 months before diagnosis.

—Only a quarter of women with ovarian cancer got pelvic imaging or CA125 blood tests in the 4 to 36 months before their diagnosis. Instead, most got abdominal imaging or gastrointestinal tests, which may not be as likely to note ovarian cancer. That could have delayed cancer diagnosis in some patients, the researchers write.

CA 125 is not a specific cancer screening test. It is associated with a variety of noncancerous and common conditions including pelvic inflammatory disease, endometriosis, pregnancy, menstruation, and even fibroids. A normal blood level alone does not necessarily mean no cancer.

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Researcher's Conclusions

"The study has two main conclusions," Smith tells WebMD in the email.

"We found objective evidence that some women with ovarian cancer developed symptoms many months before diagnosis. This is supportive of previously published reports based on subjective patient questionnaire studies that suggested a similar phenomenon."

"The second conclusion is that many women having symptoms before diagnosis had testing (e.g. abdominal imaging or gastrointestinal procedures), but not pelvic imaging, which could diagnose tumor still confined to the pelvis," writes Smith.

Earlier Diagnosis?

Would different tests speed up ovarian cancer diagnosis?

Pelvic imaging and CA125 tests "may lead to an earlier diagnosis in some patients, although the sensitivity of these tests for early stage disease is not high," write Smith and colleagues.

"Our findings suggest that ovarian cancer could be diagnosed earlier in some patients whose diagnosis currently is delayed by at least four months, because physicians order abdominal imaging or perform gastrointestinal procedures before they order a test that is more likely to diagnose ovarian cancer, such as pelvic imaging and/or CA125."

They call for more research to check their findings and to see if altering the test schedule would pay off for patients.

Visit WebMD's Cancer Health Center

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Smith, L. Cancer, Oct. 1, 2005; vol 104. WebMD Medical Reference from Healthwise: "Ovarian Cancer - Symptoms." Lloyd Smith, MD, PhD, professor and chairman, obstetrics and gynecology department, University of California, Davis Health System. American Cancer Society: "How Many Women Get Ovarian Cancer?" News release, UC Davis Health System. News release, John Wiley & Sons, Inc.