Symptoms Warn of Ovarian Cancer

A symptoms checklist, combined with a blood test, can catch
80% of
ovarian cancer in its earliest, most curable stages, a new study
suggests.

Doctors used to call ovarian cancer "the silent killer."
That's because it was thought to have no symptoms until the very late stages of
disease. But women who had or who survived ovarian cancer insisted that they
knew something was wrong, long before doctors finally diagnosed their
malignancy.

Finally, a doctor listened. University of Washington researcher Barbara
Goff, MD, and colleagues analyzed patients complaints and, in a groundbreaking
2004 study, announced to the medical world that ovarian cancer is not
silent.

In 2007, Goff, M. Robyn Andersen, PhD, of Fred Hutchinson Cancer Research
Center, and colleagues came up with a "symptom index" indicative of
ovarian cancer. But this index caught only 57% of early-stage cancers.

Now the same researchers find that by adding a blood test for the CA125
ovarian-cancer biomarker -- which by itself misses about half of ovarian
cancers -- the symptom index can catch more than four out of five early ovarian
cancers.

"The symptom index and the CA125 test each finds 50% to 60% of women
with early disease," Andersen tells WebMD. "But when they're combined,
if either one is positive, we might be able to identify 80.6% of women with
early stage ovarian cancer. Women with early stage disease have good chance of
a cure -- it's just that right now, we don't find many of them in
time."

Ovarian Cancer: Symptoms to Look For

The symptoms that warn of ovarian cancer aren't, in themselves, very
specific. They may seem to be gastrointestinal or psychological rather than
gynecological in nature.

"We hear all the time of women coming in with these symptoms and having
them missed or dismissed by their doctors," Cara Tenenbaum, policy director
for the Ovarian Cancer National Alliance, tells WebMD. "They get sent to
eating disorder clinics, or treated for
irritable bowel syndrome or
depression ."

But the symptoms are real, says Robert A. Smith, PhD, director of cancer
screening for the American Cancer Society. A study that looked at the health
records of women later diagnosed with ovarian cancer found that prior to their
diagnosis, they were much more likely than other women to complain of abdominal
symptoms.

So what are these warning signs? Andersen says there are three basic
symptoms:

• 
  Bloating or increased abdominal size


• Pelvic or abdominal pain


• Eating difficulty or feeling full too quickly

"This isn't something that's been going on since a woman was 18,"
Andersen says. "This is something new happening to a woman's body."

Women identified as high risk by symptom index or CA125 testing would likely
undergo transvaginal
ultrasound to look for abnormal growths on their ovaries. Such growths are
not uncommon, and the ultrasound test itself is not an appropriate test for
ovarian cancer except in women with family histories or genetic backgrounds
that put them at especially high risk.

"But if ultrasound is used in the group of women already selected
because of symptoms or CA125 or both, then we might identify which women are
the right ones to go to surgery," Andersen says. "We want to use
transvaginal ultrasound to identify the false-positives among women who did
report symptoms, so those who don't have ovarian cancer would not go to
surgery."

Unfortunately, there's only one sure way for doctors to know if a woman has
ovarian cancer: surgery.

"It is not trivial to open up the abdomen and check," mith
says.

That's why there's an intense effort under way to find a reliable way to
detect cancer of the ovaries. Until that day comes, the symptoms index plus
CA125 screening may be the best way to identify women who may have ovarian
cancer.

"Even with this specific pattern of symptoms, most women who have them
probably don't have ovarian cancer -- just as most women who find a lump in
their breast don't have breast cancer ," Andersen
says. "It is time to get it checked out, but it is still not likely to be
ovarian cancer."

Andersen, Goff, and colleagues report their findings in the Aug. 1 issue of
the journal Cancer.

By Daniel DeNoon
Reviewed by Louise Chang
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