Early warning signs for ovarian cancer

[June 14, 2007]  ATLANTA  (AP) -- For the first time, cancer experts are advising women of certain symptoms that might alert them to ovarian cancer, a medically infamous "silent killer" that is hard to spot early and is one of the deadliest tumors.

Suddenly experiencing weeks of bloating, the need to urinate frequently, eating changes and abdominal or pelvic pain -- either one of these or a combination -- could be a tip-off to early ovarian cancer, according to several groups of cancer experts.

The American Cancer Society and other organizations released a consensus statement Wednesday listing the symptoms. Historically, doctors have believed there are no early signs of ovarian cancer, which is expected to kill about 15,000 American women this year.

"There's been this myth about ovarian cancer being silent and people saying there's nothing you can do about it. Well, that's simply not true anymore," said Dr. Barbara Goff, a University of Washington cancer specialist.

There is no early screening test; a regular pelvic exam is considered the main way to detect the cancer early.

The cancer society wrote the consensus statement along with the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists.

The experts say women should see their doctor if they suddenly experience any of these symptoms daily for at least three weeks:

• Bloating.

• Pelvic or abdominal pain.

• Difficulty eating or feeling full quickly.

• Frequent or urgent urination.

But the guidelines are problematic, said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

Many women with these symptoms are more likely to have irritable bowel syndrome than ovarian cancer, she said. Also, there are no highly accurate tests to clearly confirm ovarian cancer at such an early stage.

That means pursuing the symptoms as a harbinger of ovarian cancer may, in some cases, lead to biopsies and other treatments that will do more harm than good.

"That was the frustration with this," Saslow said. But experts decided to issue the statement anyway, because important recent studies by Goff have indicated the sudden appearance of these symptoms in healthy women may be an important indicator.

Doctors said they expect media coverage of the guidelines will unleash a flood of queries from nervous women.

"I would expect an increase in calls from people wanting to come in and find out what is the cause of their symptoms. But if a patient is properly evaluated, it should not lead to an undue increase in diagnostic testing," said Dr. George Mussalli, chairman of the obstetrics and gynecology departments at St. Vincent's Hospital Manhattan.

Proper evaluation includes asking whether a woman has a family history of breast or ovarian cancer or has tested positive for a genetic mutation associated with those conditions, said Jane Langridge, who heads the National Ovarian Cancer Coalition, an advocacy group.

Women should initially be evaluated by a gynecologist, but they should go to a specialist in gynecologic cancers if more testing and treatment is contemplated, she added.

Doctors check for ovarian cancer with ultrasound, a blood test and an exam in which a doctor feels for a mass. Unfortunately, none is considered highly accurate. The blood test -- which checks for a protein that can indicate ovarian cancer -- is particularly problematic, some doctors said.

"In premenopausal women, it's almost useless. So many other factors can elevate it," said Dr. Stuart Pancer, an obstetrician-gynecologist at DeKalb Medical, an Atlanta-area hospital system.

Still, Pancer and others said it's important that more women and their doctors practice vigilance.

"We hope this is going to save lives," Goff said.

Among cancers, ovarian is the fifth-leading killer of women. It accounts for about 6 percent of female cancer deaths, according to the American Cancer Society.

Lung cancer is No. 1, accounting for more than a quarter of all female cancer deaths. Cancers of the breast, colon and rectum, and pancreas also kill more women.

Survival rates vary by age: Women younger than 65 are about twice as likely to survive at least five years after diagnosis. The overall survival rate is 76 percent after one year and 45 percent after five years.

Survival rates are much higher if the cancer is caught at an early, localized stage, but only one in five ovarian cancers are detected at that point, according to the cancer society.

[Associated Press]

AP medical writer Lindsey Tanner in Chicago contributed to this report.