Recognizing Ovarian Cancer Symptoms Reduces Misdiagnosis and Late Diagnosis

Ovarian cancer causes the most deaths among gynecological tumors. Fewer than 40% of people diagnosed with ovarian cancer can be cured, and approximately 12,810 people in the US die from the disease each year. Turkey Cancer Statistics show that in 2020, 4,059 women in Turkey were diagnosed with ovarian cancer and 2,730 women died from it.

For the past 25 years, scientists have been working to develop a cancer screening test to detect ovarian cancer at its earliest stages, when treatment is most likely to succeed. Unfortunately, numerous clinical trials involving hundreds of thousands of participants have failed to identify an effective screening method. In fact, the US Preventive Services Task Force gave ovarian cancer screening a D grade in 2018, meaning routine screening is not recommended because it does not improve survival and may harm patients.

With no effective screening test currently available, 70% of people with ovarian cancer are diagnosed at advanced stages, when treatment is more challenging. Approximately 60% to 90% of those with stage I or II cancer, confined to the ovaries and pelvis, remain disease-free 5 years after diagnosis, compared with only 10% to 40% of those with stage III or IV cancer that has spread into the abdomen and distant organs.

Another point is that even people with advanced disease have a better chance of recovery if their ovarian tumors can be completely removed surgically. This makes early diagnosis even more important for overall survival.

Without screening tests, many doctors incorrectly assume that early ovarian cancer diagnosis is impossible. As a gynecological oncologist treating hundreds of ovarian cancer patients each year, I was frustrated by these late diagnoses and wondered whether better symptom recognition could help doctors and patients diagnose ovarian cancer earlier.

Recognizable Symptoms That May Indicate Early Ovarian Cancer

Ovarian cancer has historically been called a “silent disease” because its early symptoms were thought to be undetectable. Patients were often diagnosed so late that doctors believed nothing could be done to achieve an earlier diagnosis.

However, many studies over the past 20 years have shown that ovarian cancer has early warning signs. One was conducted in 2000. A survey of 1700 people with ovarian cancer found that 95% of patients reported noticeable symptoms three to 12 months before diagnosis.

The most common ovarian cancer symptoms were;

• pain in the pelvis and abdomen,
• an increasingly frequent urge to urinate,
• difficulty eating or feeling full quickly, or
• abdominal bloating.

More importantly, people with advanced and early-stage disease reported similar symptoms. Later studies by several researchers confirmed that even patients with early-stage ovarian cancer frequently experience symptoms.

Ovarian cancer was also shown to be frequently misdiagnosed as another condition. When we asked patients what their doctors had said was causing their symptoms, 15% were attributed to irritable bowel disease, 12% to stress, 9% to gastritis, 6% to constipation, 6% to depression and 4% to other causes. Thirty percent of patients were treated for another condition, and 13% were told that nothing was wrong.

An important problem is distinguishing ovarian cancer symptoms from gastrointestinal and urinary conditions that are common in the general population.

In another study, symptoms experienced by ovarian cancer patients were compared with those of patients without ovarian cancer to facilitate early detection.

An index was developed identifying 6 important symptoms of ovarian cancer:

1. bloating,
2. increased abdominal size,
3. feeling full quickly,
4. difficulty eating,
5. pelvic pain, and
6. abdominal pain

Symptoms had to occur more than 12 times a month but have lasted less than one year.

Based on these criteria, the index detected ovarian cancer in 60% to 85% of patients in the study, a range similar to that achieved with diagnostic blood tests for ovarian cancer.

Preventing Ovarian Cancer

Although early detection is important, prevention strategies can also help reduce the risk of developing ovarian cancer.

If you have a family history of ovarian cancer, genetic testing to determine your risk or prophylactic (preventive) surgery to prevent cancer development may be recommended.

Oral contraceptives (birth control pills), tubal ligation (surgery to close the fallopian tubes), pregnancy and breastfeeding reduce ovarian cancer risk.

Finally, up to 70% of ovarian cancers may originate in the fallopian tubes. Removing the fallopian tubes during another operation may be another option to help reduce ovarian cancer risk. This should be done only if you do not plan to become pregnant in the future.