Ovarian cancer checklist

Ovarian cancer is often called the “silent killer” because it is often not diagnosed until the later stages, when symptoms develop due to its spread from the ovaries to other organs. Ovarian cancer is both the fifth most diagnosed (accounting for 4 percent of all new cancers) and the fifth leading cause of cancer deaths (accounting for almost 5 percent) among Canadian women.

Doctors have known that ovarian cancer is not quite as silent as it seems. Women with ovarian cancer often do complain of symptoms such as abdominal pain, or a frequent need to urinate, in the months before they were correctly diagnosed. But because these symptoms can have a variety of causes, many women don’t see the doctor right away – and when they do, doctors have often spent time investigating other possibilities before coming to a diagnosis of ovarian cancer.

But this summer researchers at the University of Washington have come up with an “early-warning system” for women and doctor alike – a checklist of symptoms that may herald the disease.

The study found that the symptoms most common in women who turned out to have ovarian cancer were bloating, increased abdominal size, fatigue, urinary urgency, abdominal pain, and pelvic pain.

Checklist may be too vague
These are common symptoms for healthy women as well – and that is part of the concern that doctors have in releasing a checklist of symptoms.

Despite its status as the fifth leading cause of cancer death in Canada, ovarian cancer is relatively rare, making screening tests more likely to generate false alarms than to find early cancers. In one study, Swedish researchers used vaginal ultrasound to screen 805 women considered at elevated risk for ovarian cancer, and 39 women then underwent exploratory surgery to investigate suspicious tissue masses found with ultrasound. But only one had ovarian cancer. And since most women will experience these symptoms at some point in their lives, it may be unnecessarily stressful to encourage them to consider whether they should be checked.

Generally the recommendation has been to screen for ovarian cancer if there is a family history of particular types of cancer.

And of course there could be a strain on the medical system if waiting rooms are suddenly flooded with women experiencing cramps or gassiness.

But the study’s authors believe their checklist can be a significant tool in the fight against cancer. When compared with women visiting two primary care clinics at the University of Washington, those with ovarian cancer were significantly more likely to have bloating, increased abdominal size, urinary urgency, and/or abdominal or pelvic pain. They also had a significantly greater number of symptoms (a median of 8 symptoms versus 4 for the clinic patients).

Women with tumors also typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or the control group participants. The combination of bloating, increased abdominal size, and urinary symptoms was found in 43 percent of those with cancer but in only 8 percent of those reporting to primary care clinics.

Given these results, the University of Washington team released the checklist below. It has already been adopted by over 20 organizations in the United States, despite concerns.

Take-home message for patients?
What’s the bottom line? Even if Canadian organizations have not yet adopted the checklist, if you find that you find the descriptions – and particularly if you have a family history of cancer – make an appointment to go in and get checked out. But don’t assume the diagnosis will be ovarian cancer.

Women should check with a physician or other health-care professional if they have one or more of these new symptoms which persist for more than three weeks:
• Abdominal swelling or bloating
• Abdominal or pelvic pain or pressure
• Gas, indigestion, nausea or changes in bowel habits
• Vaginal bleeding or discharge
• Urinary urgency, burning or spasms

Risk factors for ovarian cancer
• Family history of ovarian or breast cancer
• Never bearing children
• Caucasian race
• Jewish descent
• Infertility
• Starting periods at a young age
• Menopause at an older than average age
• High-fat diet

Factors that lower the risk of ovarian cancer
• Use of birth-control pills
• Having many children
• Breast feeding
• Tubal ligation
• Removal of ovaries

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