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Stomach Pain, Swelling Could Signal Ovarian Cancer

MONDAY, Aug. 22 (HealthDay News) -- Abdominal pain and swelling can be early symptoms of ovarian cancer. But they are often attributed to other causes, potentially delaying an earlier diagnosis of the disease when it could be treated more effectively, a new study finds.

After reviewing the medical records of nearly 20,000 women, researchers found that as early as 12 months before diagnosis, women with ovarian cancer were twice as likely as women without the disease to report these symptoms to their doctors. But they were initially treated for stomach problems rather than given tests for the cancer.

"This study lends support to the idea that some women are having symptoms before diagnosis [of ovarian cancer] and could possibly have an earlier diagnosis if appropriate tests were offered earlier," said study author Dr. Lloyd H. Smith, chairman of the department of obstetrics and gynecology at the University of California, Davis.

"Having these symptoms is very unlikely to mean ovarian cancer," Smith added, because the symptoms are common and ovarian cancer is rare. But if the symptoms can''t at first be attributed to another cause, it would be wise for a doctor to recommend that a woman be administered pelvic imaging and a serum test, called CA125, that can indicate ovarian cancer, he said.

The study results appear in the Oct. 1 issue of the journal Cancer.

Ovarian cancer is a fast-growing cancer, progressing from early to advanced disease in as little as a year. While the rate of ovarian cancer has declined since 1991, it is the fourth-leading cause of cancer death among U.S. women. Approximately 22,000 cases will be diagnosed this year, and 16,210 women will die of the disease, according to the American Cancer Society.

"This study is very important because it tells us that ovarian cancer patients have a much higher incidence of these symptoms than do women without the disease," said Dr. Robert Morgan Jr., staff physician with the division of medical oncology and therapeutics research at the City of Hope Cancer Center, in Duarte, Calif.

"Women with ovarian cancer do have these symptoms and it behooves us as physicians to pay attention," he added.

Dr. Samuel Mok''s work in gynecologic oncology at Brigham and Women''s Hospital in Boston involves looking for biologic markers to screen for ovarian cancer. "Raising awareness among primary care physicians and sub-specialists, particularly gastroenterologists to whom these women are often referred, is a very important goal," he said.

Screening for the disease has been the thrust of much research into ovarian cancer because it had been thought to be a disease without major symptoms until its late stages, he said.

For the study, Smith and his colleagues used data from diagnosis codes for nearly 20,000 women aged 68 or older -- 1,985 of whom had ovarian cancer, 6,024 of whom had breast cancer, and an age-matched group of 10,941 Medicare-enrolled women without cancer. The group of women with breast cancer served as an extra control, Smith said, since they share some epidemiologic similarities with ovarian cancer patients.

After comparing diagnosis codes obtained from the California Surveillance, Epidemiology, and End Results (SEER)-Medicare data base, and working with researchers at the California Cancer Registry, the study researchers found that women with ovarian cancer were twice as likely as women without the disease to report symptoms of stomach discomfort, both a year and nine months before diagnosis.

Overall, 40 percent of these women had physician claims indicating one or more visits for abdominal or pelvic symptoms between 36 and four months before their ovarian cancer diagnosis.

Of this group, however, only 25 percent had diagnostic pelvic imaging or CA125 serum tests up to four months before diagnosis. Most had abdominal imaging or diagnostic gastrointestinal tests, which would be less likely to lead to a correct diagnosis. By contrast, 54 percent of ovarian cancer patients received pelvic imaging or CA125 serum testing within three months before their ovarian cancer was diagnosed.

"It''s not wrong to do gastrointestinal tests, but if these tests come back negative, you need to consider that it could be a gynecological issue," Morgan said.

More information

The American Cancer Society has more on ovarian cancer and its symptoms.



SOURCES: Lloyd H. Smith, M.D., Ph.D., chairman, department of obstetrics and gynecology, University of California, Davis; Robert Morgan Jr., M.D., staff physician, division of medical oncology and therapeutics research, City of Hope Cancer Center, Duarte, Calif.; Samuel Mok, M.D., Ph.D., director, lab for gynecologic oncology, Brigham and Women''s Hospital, Boston; Oct. 1, 2005, Cancer

Last Updated: Aug-22-2005
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