Abdominal swelling and pain commonly precede ovarian cancer diagnosis

Abdominal swelling, pain, and other target symptoms are common in the months before ovarian cancer is diagnosed, according to a report in the August 22nd early release of Cancer.

“Some patients with ovarian cancer do report symptoms many months before their ultimate diagnosis, and some ovarian cancer patients could have had an earlier diagnosis if pelvic imaging was included in their workup,” Dr. Lloyd H. Smith from University of California at Davis, School of Medicine, Sacramento, told Reuters Health.Dr. Smith and colleagues used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program and from Medicare Part B claims for California women who developed ovarian cancer to investigate whether symptoms preceded a diagnosis of ovarian cancer and whether an earlier clinical diagnosis is possible in patients with ovarian cancer.Data for 1985 women with ovarian cancer, 10,941 with breast cancer and 6024 control subjects without cancer were included in the analysis.Abdominal swelling and pain were significantly more common 6 months prior to diagnosis in the women with ovarian cancer than among women in the noncancer and breast cancer control groups, the authors report.In the 1-to-3 months prediagnosis, gastrointestinal symptoms and pelvic pain were also more common among women diagnosed with ovarian cancer than among women in the two control groups.Forty percent of women diagnosed with ovarian cancer had at least one target symptom code during the 4-to-36 months prediagnosis, the researchers note, and 7.4% had claim codes for at least one target symptom 10-to-12 months prediagnosis.In the 4-to-36 months before diagnosis, 61.1% of women with target symptoms had abdominal imaging, 30.8% had gastrointestinal procedures, and 25.3% had pelvic imaging or measurement of CA125 levels, the results indicate. These rates were significantly higher than in the two control groups.”Our findings suggest that ovarian cancer could be diagnosed earlier in some patients whose diagnosis currently is delayed by at least 4 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,” the authors conclude.”Since we were measuring symptom codes, not actual symptoms, we are unable to accurately estimate the proportion of patients who became symptomatic prior to diagnosis,” Dr. Smith explained.”We would like to increase the power of the study and look at symptoms in patients with early disease and, if feasible, look at symptom duration and survival,” Dr. Smith said. “These studies could help us understand if early symptom detection could have a significant impact on ovarian cancer survival.””If routine medical evaluation fails to explain the symptoms and they persist, then testing for ovarian cancer should be considered,” Dr. Smith concluded. “As is true for many diagnostic tests in the setting of symptom evaluation, many patients may have a negative test.”(Source: Cancer 2005: Reuters Health: Will Boggs, MD: Oncolink: August 2005.)