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Ovarian Cancer Symptoms Are Not Silent

CancerWise - October 2007


By Dawn Dorsey

Judith Wolf, M.D., associate professor in the Gynecologic Oncology Center at
M. D. Anderson, knows from personal and professional experience that ovarian cancer's reputation as a silent killer is seriously off target.

A recent consensus statement by the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists outlined symptoms that may lead to early detection of ovarian cancer, the most dangerous of the gynecological cancers.

When the new guidelines were published recently, one of Wolf's friends read a newspaper article about them and realized she was having symptoms. Shortly after, Wolf's friend was diagnosed with ovarian cancer.

In her practice, Wolf sees many ovarian cancer patients who have had subtle, but persistent, symptoms they did not recognize except in hindsight.

Early diagnosis is key

Although ovarian cancer is rare, it is deadly.

In the United States, ovarian cancer:

  • Strikes more than 22,000 women each year
  • Causes more than 15,000 deaths each year
  • Is the fifth most common cause of cancer deaths in women

There is good news and bad news about early detection. The good news is that 93% of women diagnosed with early stage ovarian cancer will survive at least five years, and most of them will be cured. The bad news is that only 19% of ovarian cancers are found in the early stages before they have spread to other parts of the body.

Symptoms can be tricky

The new guidelines detail possible signs of the disease to help with early diagnosis.

Possible symptoms of ovarian cancer include:

  • Bloating
  • Pain in the:
    • Pelvic area
    • Abdomen
    • Lower back
  • Trouble eating or a feeling of getting full quickly
  • Urinary symptoms (increased urgency, frequency)
  • Fatigue
  • Nausea
  • Pain during intercourse
  • Constipation
  • Unusual menstrual changes
  • Bleeding after menopause

What's the catch? These symptoms are vague and sound familiar to almost every woman.

"The symptoms are nonspecific, and most women experience a lot of them as their hormones fluctuate," Wolf says. "Women are used to experiencing unusual symptoms and just chalking them up to hormonal changes."

But, these symptoms may indicate ovarian cancer if they:

  • Are new symptoms
  • Last more than a few weeks
  • Occur more than 12 times a month

Other problems must be ruled out

While women often don't recognize these signs in ovarian cancer's early stages, many times they realize later they did have symptoms.

"Many times patients say they had no symptoms," Wolf says. "But when they are quizzed, they reveal they had bloating, lower back pain and other signs. They just didn't recognize these as symptoms of ovarian cancer."

The new national guidelines recommend that if a woman has these symptoms frequently and persistently she should see a physician, preferably a gynecologist. While it is unlikely these symptoms are ovarian cancer, it should be ruled out.

Most likely, a doctor will first rule out other, more common causes of these symptoms, such as irritable bowel syndrome.

Physicians must be informed, too

Women, as well as physicians, need to know to pay attention to these symptoms and at least consider ovarian cancer.

"If a woman has these symptoms and goes to a doctor, she should not hesitate to ask if it is possible she has ovarian cancer," Wolf says. She says many patients who come to M. D. Anderson with a diagnosis of ovarian cancer visit several doctors before they are diagnosed.

Wolf says doctors need to be educated as well.

"It's important that frontline doctors who see patients when they first report symptoms be aware of this constellation of symptoms," she says. "Ovarian cancer is rare and the symptoms are nonspecific, so doctors don’t always think of it first. We need to educate doctors, and women should be proactive in talking to their physicians about the possibility of ovarian cancer."

Tests may help early diagnosis

Generally, a woman with symptoms who goes to a doctor should get a full physical and gynecological checkup, including a manual pelvic examination.

After the doctor rules out other problems, a woman may be given a pelvic ultrasound or CA 125 blood test, which measures a protein that is higher in some women with ovarian cancer. She also may receive a colonoscopy or computed tomography (CT) scan to trace the origin of the symptoms.

Currently, the ACS does not recommend these types of tests for ovarian cancer in women who do not have symptoms or are at low risk. Although research continues to find a screening test for ovarian cancer, available tests listed above are not accurate enough for widespread use.

Physicians hope boosting awareness of the symptoms will help more women be diagnosed while their cancer is in the earlier, more curable stages.

"We still don’t know if identifying symptoms will help," Wolf says. "But we know that if we can find this cancer early there is a good chance for a cure."

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© 2014 The University of Texas MD Anderson Cancer Center