Nov. 19, 2004 ROCHESTER, Minn. -- Results from an Olmsted Medical Center and Mayo Clinic study analyzing symptoms recorded in the medical records of ovarian cancer patients suggest ovarian cancer, long considered asymptomatic until late-stage cancer develops, does in fact have early symptoms, including urinary incontinence and abdominal pain.
"Ovarian cancer is called 'the silent killer,'" says Barbara Yawn, M.D., director of research at Olmsted Medical Center and the study's lead investigator. "We know now that there are symptoms, yet it appears that women ignore them and physicians don't recognize the potential urgency of evaluating the symptoms."
The most common symptom found in the records of the 107 ovarian cancer patients studied was crampy abdominal pain. Abdominal pain and urinary urgency, frequency or incontinence were the most commonly documented symptoms in women who had Stage I and II, the early stages, of ovarian cancer. In patients with Stages III and IV cancer, the later stages, abdominal pain and increased abdominal girth were the most commonly documented symptoms. Fewer than 25 percent of the symptoms would be considered unique to ovarian cancer or related directly to the reproductive pelvic organs: the uterus, fallopian tubes, cervix and ovaries. The study found the following factors associated with a longer time to diagnosis of patients' ovarian cancer: delays in women seeking medical care, health care system issues, competing medical conditions, physicians' failure to follow up, and women not returning for follow-up.
Brigitte Barrette, M.D., a Mayo Clinic gynecologist and study investigator, found the commonality of urinary leakage symptoms among the ovarian cancer patients particularly interesting. "My surprise with our findings was at the urinary incontinence, because it's not something that has been reported often," she says. "Sudden or marked change in urinary leakage was a symptom. So, incontinence problems that develop over a period of just a few weeks are something to pay attention to."
The difficulty in differentiating symptoms of abdominal pain and urinary incontinence as ovarian cancer predictors lies in the many different diseases or conditions to which these symptoms may point. "Many of the symptoms are more common in other conditions, such as irritable bowel syndrome or colon cancer," says Dr. Yawn.
Looking for ovarian cancer is a bit like looking for a zebra in a field of horses. "Someone can go to the doctor with bloating, and usually the physician will investigate for the common things," says Dr. Barrette.
"It's like when someone goes to the emergency room with a headache. Most of the time, it's not a stroke. But, that should be considered."
Due to the fact that the symptoms identified in this study can be indicative of many conditions, Drs. Yawn and Barrette suggest that women and their doctors be particularly alert to incontinence and abdominal pain that do not improve with treatment. "When a woman goes in to see her doctor with these abdominal, urinary or pelvic symptoms and the tests for the most common causes are negative, the workup needs to continue," says Dr. Yawn. "Ovarian cancer must be considered. If the symptoms persist and there is not a clear reason, you need to look further." At a minimum, the symptoms require a pelvic examination with an ultrasound and a blood test for ovarian cancer if they do not resolve or do not have another very clear diagnosis within weeks -- not months, agree Drs. Yawn and Barrette.
Another barrier to catching ovarian cancer early is that the cancer's progression is almost entirely in the body's interior. "The diagnosis is so tricky because there is room in the abdomen, and an ovary can grow, form a big mass and progress without the patient even noticing," says Dr. Barrette. "You can't feel it from the outside -- it's inside, and we in the medical community don't have any screening test specifically for ovarian cancer."
Drs. Yawn and Barrette indicate that the symptom of abdominal pain most likely originates from pressure from the tumor or from fluid in the abdomen prompted by the tumor's presence. Urinary incontinence is most likely due to the tumor's pressing on the bladder and causing increased pressure within the abdomen, prompting urine loss.
Dr. Yawn explains that from the data collected in this study, the investigators are unable to draw conclusions about whether catching a patient's symptoms early in the progression of ovarian cancer will make a difference in the treatability of her cancer. Prior studies addressed that issue.
"We know if ovarian cancer is detected at an earlier stage, the survival is about 90 percent; we know that an early stage can make a difference," says Dr. Yawn. Dr. Barrette points out, however, that ovarian cancer can progress from stage to stage in a matter of months, making it far more aggressive than malignancies such as breast cancer.
Ovarian cancer occurs in 1 out of 70 women.
This study was published in the October issue of Mayo Clinic Proceedings, http://www.mayo.edu/proceedings. Study authors include Dr. Yawn, Dr. Barrette, and Peter Wollan, Ph.D., Olmsted Medical Center.
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