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
