SAN DIEGOMost women with ovarian cancer have previous abdominal
or gastrointestinal (GI) complaints, and diagnoses are often delayed
because neither patients nor physicians recognize these early warning
signs, Barbara A. Goff, MD, reported at the 31st Annual
Meeting of the Society of Gynecologic Oncologists (SGO).
In the United States, 70% of women with ovarian cancer are currently
diagnosed with stage III or IV disease, Dr. Goff, of the University
of Washington School of Medicine, said in an interview with ONI.
In nearly every case, the patients have previously experienced
abdominal or GI complaints, pain, constitutional symptoms, urinary
problems, or vaginal symptoms.
In our study, only 11% of women with stage I/II disease and 3%
with stage III/IV disease reported no symptoms prior to their
diagnosis, she said.
Data for this national study were drawn from a two-page survey
distributed to 1,500 readers of an ovarian cancer newsletter. The
surveys could be photocopied and given to other patients. A total of
1,725 surveys were returned from women in 46 states and four Canadian
provinces, and 70% had stage III or IV disease.
and GI symptoms were the most commonly reported complaints (see
Table). These typically included feeling full after eating a
small amount, bloating, constipation, and/or abdominal pain,
Dr. Goff told ONI.
Women who ignored their symptoms were significantly more likely to be
diagnosed with advanced disease, compared with those who did not, she
said. The time required for a health care provider to make the
diagnosis was reported as less than 3 months in 55% of cases, but
greater than 6 months in 26% and greater than a year in 11%, Dr. Goff said.
Delay in diagnosis was significantly associated with omission of a
pelvic exam at first visit; having a multitude of symptoms; being
diagnosed initially with no problem, depression, stress, irritable
bowel, or gastritis; not initially receiving an ultrasound, CT, or
CA-125 test; and younger age.
I was surprised by the large percentage of patients who had
delays in diagnosis of 3 or more months. Dr. Goff said. Delay
in diagnosis did not correlate with the type of physician seen
initially, type of insurance coverage, or specific symptoms experienced.
Based on these data, Dr. Goff recommends careful pelvic examination
of any woman who presents with pelvic or abdominal complaints. She
recommends ultrasound or CT examination for any women with persistent
pelvic or abdominal complaints, and CA-125 assay if the ultrasound or
CT scan shows an ovarian mass.
Women with ovarian cancer do have symptoms, and both women and
physicians need to be aware of what these are. In addition, delay in
diagnosis is common, and we need to identify ways to improve
this, she said.