For the first time, cancer experts are advising women of symptoms that might be a sign of ovarian cancer, a disease that is notoriously hard to detect early -- and notoriously deadly.
According to several groups of cancer experts in the U.S., suddenly experiencing weeks of bloating, the need to frequently urinate, eating changes and abdominal or pelvic pain could be a tip-off to early ovarian cancer,
The guidelines -- developed by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society -- urge women who suddenly develop the following symptoms for more than a few weeks to see their doctors:
- Bloating
- Pelvic or abdominal pain
- Feeling full quickly or difficulty eating
- Frequent or urgent urination
The new advice is the first official recognition that ovarian cancer, long believed to be a "silent killer" that gives no warning of its presence until it is far advanced, causes symptoms at earlier stages in many women.
"We used to think ovarian cancer was very slow-growing, that it was aggressive and people did not have symptoms early," Dr. Barry Rosen of the Society of Gynecologic Oncologists of Canada told Â鶹ӰÊÓ.
"Now we believe symptoms occur much earlier. And it suggests to me the cancer is not always rapidly growing and it may be able to be detected in the early stages."
Awareness of the symptoms is not altogether new; indeed, a similar list has been posted on Ovarian Cancer Canada's website for a while. But unfortunately, until now, there had been no agreement on common symptoms.
Elizabeth Ross, CEO of Ovarian Cancer Canada, said she hopes the new warnings will be heeded by doctors.
"I hope that it will mean it's now on the radar screen for doctors when women come in -- women complaining of abominal pain, bloating, urinary frequency -- that it won't be dismissed as menopausal symptoms," she told Â鶹ӰÊÓ.
Dr. Rosen says the Society of Gynecologic Oncologists of Canada will meet in a week to discuss this the guidelines and may issue their own statement that they agree with the U.S. consensus statement.
The American groups said they considered adding more symptoms to the list, including: fatigue, back pain, pain with intercourse, and menstrual irregularities, among others. But they decided those symptoms are too often found in equal frequency in women who do not have ovarian cancer.
Doctors say they hope the new recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives.
"My hope is that it raises awareness among women who may have symptoms, and among family physicians who see women with bowel symptoms," says Dr. Rosen.
However, the American Cancer Society's director of breast and gynecologic cancer says the guidelines are problematic. Debbie Saslow says many of the women with one or more of the symptoms are more likely to have irritable bowel syndrome than ovarian cancer.
Also, she worries that women may needlessly undergo biopsies and other treatments that will cause more harm than benefit.
The experts decided to issue the statement anyway, because important recent studies have indicated the sudden onset of the symptoms in healthy women may be an important indicator.
It is estimated that 2,400 new cases of ovarian cancer will be diagnosed in Canada in 2007. As well, 1,700 women will die of the disease in this country in 2007.
Part of the reason for the high death rate is that 70 per cent of women with the disease are not diagnosed until they are at either Stage 3 or 4 of the disease, when treatment success rates are low.
"A woman who presents with Stage 1 of 2 cancer has an 80 to 90 per cent chance of cure," says Rosen. "At Stage 3 or 4, the likely cure rate is 15 to 20 per cent. So there is an enormous advantage to detecting ovarian cancer early."
The lifetime probability of a woman developing ovarian cancer in Canada is one in 69.
It's not known what causes ovarian cancer but it is more common in:
- Women over 50;
- Those with a family history of ovarian cancer or breast cancer;
- And in those who have taken hormone replacement therapy (HRT).
The factors that appear to decrease the risk of ovarian cancer are:
- Pregnancy
- Taking the birth control pill
- Breastfeeding
- Tubal ligation and total hysterectomy
With a report from CTV medical specialist Avis Favaro and medical producer Elizabeth St. Philip