Women diagnosed with ovarian cancer, one of the most lethal women's cancers, might have a better prognosis if they and their doctors were more familiar with its symptoms and if appropriate tests were done sooner. These study results were published in the Nov. 15 journal Cancer (Vol.89, No. 10: 2068-2075).
Ovarian cancer is difficult to diagnose early because its symptoms include indigestion and abdominal swelling, which are also signs of many conditions other than cancer.
To find out why diagnosis is often delayed and to help identify symptoms of ovarian cancer, Barbara A. Goff, MD, assistant professor of obstetrics and gynecology at the University of Washington in Seattle, and her team examined the results of surveys completed by 1,725 women in 46 states and four Canadian provinces.
Findings of the StudyAlmost 90% of the women in the study who were diagnosed in early stages reported having one or more symptoms, such as abdominal pain, bloating, pelvic pain or back pain. Only 3% of women diagnosed with advanced ovarian cancer did not report any symptoms.
For just 55% of all the women surveyed was the correct diagnosis made within two months after symptoms appeared. It took three to six months for 19% of the women, and more than a year for 11%. The longer diagnosis took, the more advanced the cancer was.
In some cases, women with symptoms delayed their diagnosis by waiting an average of two to three months before reporting them to doctors, with 22% of the women surveyed saying they ignored their symptoms, most because they were unaware their symptoms could be due to cancer.
"Everyone has gas and indigestion from time to time, and perhaps some abdominal swelling or back pain or pelvic pain, but if these non-specific symptoms persist, they should be reported," Goff says. She adds that doctors also need to consider ovarian cancer when diagnosing women with these symptoms.
Some Told Nothing Was WrongWhen they did report symptoms, one-third of the women were not given a pelvic exam at the first visit and 30% received treatment for another disease before the correct diagnosis was made. Many were told their symptoms were due to irritable bowel syndrome, stress, gastritis, depression or constipation, or that nothing was wrong at all. Only one-fifth were told at their first visit they might have ovarian cancer. About one-third were not correctly diagnosed until they had seen three or more health care providers, and many felt their concerns were not taken seriously.
About 95% of women diagnosed with ovarian cancer survive five years or more if they are diagnosed before the cancer spreads beyond the ovaries -- but only about one-quarter of women with ovarian cancer are diagnosed this early . The 5-year survival rate drops to about 79% if the cancer has spread to tissues near the ovary, and plummets to 28% when more distant spread has occurred.
An expert on ovarian cancer affiliated with the American Cancer Society (ACS) says the study should be interpreted with caution, in part because the women who answered the survey may not have remembered their symptoms before diagnosis perfectly. But the main points of Goff's research are worth remembering, says Carolyn D. Runowicz, MD, professor and director of the division of gynecologic oncology at the Albert Einstein College of Medicine in New York.
Avoid Delayed Diagnoses"As a doctor, I know that when a patient perceives something, it's usually real, and if patients are telling us their symptoms are being misperceived or ignored, it's probably true," says Runowicz, who is a member of the ACS advisory board on gynecologic cancers. She says several actions can help avoid delayed diagnoses.
"Women with symptoms should have a pelvic exam, and all women should have a good physical exam every year that includes breast, pelvic and rectal exams; that will check for most women's cancers," she says.
"Physicians examining women with non-specific symptoms such as those described in the study should begin with a pelvic exam," Runowicz says. "If they don't feel anything, they might want to go on to a transvaginal ultrasound to visualize the ovaries, or begin a gastrointestinal tract workup."
Runowicz agrees with Goff that if delays in diagnoses could be eliminated through increased patient and doctor awareness, more women with the disease could be cured and others helped to live longer.
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