EARLY DETECTION OF OVARIAN CANCER: STILL A BIG PROBLEM

(November 2001)

Cancer of the ovary is a ferocious cancer with a high death rate. There are 23,000 new cases and 14,000 deaths in the United States each year. This cancer is usually detected late, when there is involvement well beyond the ovary itself; at that point, the five-year survival rate is less than 40 percent. On the other hand, if it is detected early, the five-year survival rate is about 80 percent. The unresolved question is how to diagnose it promptly so instead of 70 percent of patients showing up with advanced disease, 70 percent or more would have early disease, allowing higher cure rates.

Ovarian cancer has been called a silent disease, but an article in the November 15, 2000 issue of the journal Cancer argues that even localized ovarian cancers result in symptoms in almost 90 percent of cases.

Symptoms included abdominal bloating, increased abdominal size, indigestion, abdominal pain, discomfort in the pelvic area, urinary symptoms, and fatigue. Sixty percent of the women surveyed said they had those symptoms for three months or longer prior to diagnosis, and there frequently was a considerable delay in establishing the correct diagnosis. The authors argue that, in reality, ovarian cancer is not a silent disease and that, if physicians were more alert to symptoms, the diagnosis could be made more rapidly at earlier stages of the disease, and this would result in much better outcomes.

Commentary: This is an interesting article, but it has lots of problems. The questionnaire was filled out by a woman subscribing to an ovarian cancer newsletter. They may have a biased recall of symptoms. Besides, there was no confirmation of symptoms by review of the medical records.

The point about physicians being alert to symptoms that might suggest ovarian cancer is a good one, but many of the symptoms are vague and non-specific. It is not surprising that the diagnosis is often delayed in this treacherous disease. Furthermore, in this study, those with more advanced cancer had a lot more symptoms than those with less advanced disease. That makes it even harder to establish the diagnosis early in those who would benefit the most from prompt diagnosis and treatment - those with localized, more readily treatable disease.

As the authors point out, there are no good tests that will diagnose ovarian cancer early enough to make a difference. Likewise, the pelvic examination by a physician is not a good way of detecting ovarian cancer in its early stages.

At present, we have no good screening tests for ovarian cancer. Whether paying more attention to abdominal or other symptoms will allow earlier diagnosis of less advanced ovarian cancers and make any difference in outcome is not at all clear.

Goff, Barbara A. Ovarian Carcinoma Diagnosis. Cancer. Vol 89. (November 15) Pgs 2068-2075. 2000.