Ovarian cancer is the seventh most common cancer and the fifth leading cause of cancer death among American women. The most challenging aspect of ovarian cancer is diagnosing it. Only about a quarter of ovarian cancers are diagnosed in an early stage, when the expected survival is 70% to 90%. Unfortunately, about 60% are diagnosed after the cancer has spread, when the expected survival is 20% to 30%.

Previously, symptoms of ovarian cancer were not thought to develop until the cancer was far advanced, leading some to refer to the disease as a “silent killer.” But more recent studies have suggested that certain symptoms, including bloating, abdominal pain, fatigue, urinary frequency, and constipation , may be early warning signs of ovarian cancer.

A new study in the June 9, 2004 issue of the Journal of the American Medical Association found that while symptoms associated with ovarian cancer are common in all women, they are more severe, more frequent, and of a shorter duration in women with ovarian cancer.

About the Study

This study included 1,709 women who either visited one of two primary care clinics at the University of Washington (clinical group), or were about to have surgery to remove an undiagnosed ovarian or pelvic mass. All of the women filled out an anonymous survey, in which they reported the frequency, severity, and duration of a list of symptoms typically associated with ovarian cancer:

  • Pain (pelvic, abdominal, back)
  • Eating (indigestion, unable to eat normally, nausea or vomiting, weight loss)
  • Abdomen (abdominal bloating, increased abdomen size, able to feel abdominal mass)
  • Bladder (urinary urgency, frequent urination)
  • Bowels (constipation, diarrhea )
  • Menstrual period (menstrual irregularities, bleeding after menopause )
  • Sexual intercourse (pain or bleeding during intercourse)
  • Other (fatigue, leg swelling, etc.)

The researchers compared symptoms in women with ovarian cancer to symptoms in women with non-cancerous masses and women in the clinical group. The researchers performed an additional analysis to compare the women with cancer to the women in the clinical group who had irritable bowel syndrome (IBS), which is associated with many of the same symptoms as ovarian cancer.

The Findings

Approximately 95% of the women in this study reported at least one symptom in the past year. The most common symptoms were back pain (45%), fatigue (34%), indigestion (28%), constipation (24%), abdominal pain (22%), and urinary tract problems (16%).

Of the 128 women with ovarian or pelvic masses, 84 were benign and 44 were cancerous (11 early-stage and 33 advanced). Women with benign tumors and ovarian cancer had similar complaints, but women with cancer reported twice as many symptoms as did women with benign masses.

Women with ovarian cancer were significantly more likely to have pelvic and abdominal pain, difficulty eating, bloating, increased abdominal size, and urinary urgency, compared with women in the clinical group.

Women with ovarian cancer and IBS both had severe symptoms, but bloating and urinary tract symptoms were more severe in women with ovarian cancer than in women with IBS.

The presence of coexisting symptoms helped distinguish women with cancer. Specifically, 43% of women with ovarian cancer, compared with 10% with benign masses, 13% with IBS, and 8% in the clinical group, had a combination of bloating, increased abdominal size, and urinary urgency.

Women with benign or cancerous masses experienced symptoms almost daily, compared with 2–3 times per month in the clinical group. And women with ovarian cancer typically experienced symptoms for six months or less, while women with IBS and women in the clinical group had symptoms that lasted for 12–24 months.

How Does This Affect You?

These findings suggest that the presence of certain symptoms may be linked with ovarian cancer, especially if those symptoms are experienced in certain patterns. To date, no screening test has been shown to be effective in reducing the development or death rate associated with ovarian cancer. However, despite its reputation as the “silent killer”, this study adds to previous research indicating that ovarian cancer can be identified early in some women, based on their presenting symptoms.

It is possible that identifying these symptoms early may enable physicians to diagnose ovarian cancer earlier. Theoretically, detecting ovarian cancer in its early stages can dramatically increase the chances of survival. Women should alert their doctors if they are experiencing any worrisome symptoms, especially almost daily occurrences of pelvic and abdominal pain, bloating, increased abdominal size, and urinary tract problems.

But it’s important to keep in mind that the vast majority of women with these symptoms will not turn out to have ovarian cancer, and women need not be overly concerned when they inevitably experience one or more of these symptoms. The study does, however, raise the possibility that increased vigilance on the part of physicians for certain symptom patterns may increase the detection rate of early ovarian cancer, when treatment is likely to be more successful. This is welcome news, at least until we have effective methods of screening for ovarian cancer in women with no symptoms at all.