Many women with ovarian cancer can go undiagnosed for months because their symptoms are not always being investigated promptly, warn researchers in a study published on bmj.com today.
The study identifies three key symptoms associated with ovarian cancer that should help clinicians decide whether to investigate further. Yet one of these symptoms is not included in current guidance for urgent investigation.
Ovarian cancer accounts for 4% of all cancers in women and has the worst prognosis of all gynaecological cancers. Until recently, ovarian cancer was thought to have few symptoms and was often dubbed the "silent killer" but recent studies have shown that symptoms are common and that their early identification has the potential to improve prognosis.
In the study, seven symptoms were associated with ovarian cancer: abdominal distension, urinary frequency, abdominal pain, postmenopausal bleeding, loss of appetite, rectal bleeding, and abdominal bloating. Some women presenting with the first three of these symptoms waited at least six months before the diagnosis was made.
The fact that symptoms are common and often reported is encouraging as it means there is some chance of identifying early ovarian cancer by using symptoms, say the authors. This study provides an evidence base for selection of patients for investigation, both for clinicians and for developers of guidelines, they conclude.
There is now increasing evidence that ovarian cancer is not a "silent killer" but one that presents with vague symptoms that have a low positive predictive value for cancer, writes Dr Robin Fox in an accompanying commentary.
This study adds to the evidence base derived from primary care of red flag symptoms for several cancers, and is important as most patients in the United Kingdom present initially to primary rather than secondary care, he writes.