Detecting ovarian cancer early
is notoriously difficult. Now cancer experts in the
US have issued a consensus statement with a new list
of symptoms that studies confirm are early signs of
the deadly disease. The group has put out the call for
doctors to watch for persistent symptoms to stop the
insidious cancer before it kills.
The Society of Gynecologic Oncologists
of Canada (GOC) has already answered their call —
and is sending out its own message to Canadian colleagues.
"We hope this list might bring the symptoms of ovarian
cancer to the forefront of doctors' minds when they
see patients for regular checkups," says Society president
Dr Barry Rosen. "The symptoms don't have to be severe,
only persistent. If they've increased in intensity or
severity or the patient has felt them over the last
two to three weeks, then ovarian cancer is something
their doctor should consider seriously."
Symptoms to watch for are abdominal
swelling or pelvic discomfort, pressure or pain; indigestion
or feeling full quickly; and more frequent or urgent
urination. A change in bowel habits, pain during intercourse,
and pain in the lower back or leg, among others, are
also potential indicators, according to the Canadian
Cancer Society.
'SILENT
KILLER'
These vague and hazy signs may easily lead physicians
to mistake them as indications of more common diseases
like irritable bowel syndrome, one reason ovarian cancer
has been labelled a 'silent killer.' Their occurrence,
however, is consistent. A stunning 95% of women with
ovarian cancer exhibit the symptoms of the disease,
says Dr Prafull Ghatage, program director of gynecologic
oncology at the University of Calgary, citing an article
published in Cancer in 2000. Thirty-five percent
of them exhibited symptoms for six months or more before
being diagnosed, he adds.
Unfortunately there are no effective
screening tests for ovarian cancer. "CA125 blood tests
have a very small chance of preemptive discovery," notes
Dr Ghatage. The disease is often found only after the
patient has been experiencing symptoms for some time
and by then most tumours are in a more advanced stage.
Women who are especially vulnerable are those over 50
or those who have taken hormone replacement therapy.
GET
TESTING, DOC
If the patient's symptoms raise suspicions GPs can perform
a couple of physical exams before sending them for testing
or referring them. "Perform a thorough pelvic exam and
take into consideration whether the patient has had
a pap smear in the past year," says Dr Rosen. Dr Ghatage
also recommends a bimanual rectovaginal exam.
"Then if there are still concerns,
schedule an ultrasound for the patient. It's simple
and gives good information," adds Dr Rosen. Ordering
a CA125 tumour marker blood test is also recommended.
Both doctors agree patients with any test results triggering
concern should be immediately referred to a gynecologic
oncologist rather than a gynecologist.
Occasionally unnecessary surgeries
or biopsies are performed under the suspicion of ovarian
cancer created by false positives. A bulwark against
misdiagnosis, says Dr Rosen, is the Risk Malignancy
Index. "It's been adopted by us here at the Queen Mary
in Toronto, and we've been able to minimize the number
of false positives," he says. The index calculates the
patient's menopausal state with the results of the ultrasound
and the CA125 blood test. If the patient scores high
numbers in each category, and/or when the numbers from
each are combined together to create a high score, the
patient is at greater risk and doctors have good criteria
for surgery. "We go to great lengths and are very careful
to have good criteria," says Dr Rosen.
LISTEN
UP, LADIES
Every year 2,300 new cases of ovarian cancer are found
in Canadian women, according to the National Ovarian
Cancer Coalition (NOCC). And each year 1,600 Canadians
die of the disease, ranking it fifth in cancer mortality.
Dr Ghatage says awareness among
women is extremely poor. An NOCC study found 96% could
not identify symptoms of the disease, he explains, and
one in three thought there was a screening test to identify
it. With the release of a confirmed list of symptoms
everyone hopes physicians and patients will be more
vigilant. "This isn't about being prescriptive, it's
an awareness thing," says Dr Rosen. "I hope the result
of the wide dissemination of this list will help doctors
identify patients in the early stages of ovarian cancer
and therefore be able to cure more."
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