Context Women with ovarian cancer frequently report symptoms prior to diagnosis,
but distinguishing these symptoms from those that normally occur in women
Objective To compare the frequency, severity, and duration of symptoms between
women with ovarian cancer and women presenting to primary care clinics.
Design, Setting, and Patients A prospective case-control study of women who visited 2 primary care
clinics (N = 1709) and completed an anonymous survey of symptoms experienced
over the past year (July 2001-January 2002). Severity of symptoms was rated
on a 5-point scale, duration was recorded, and frequency was indicated as
number of episodes per month. An identical survey was administered preoperatively
to 128 women with a pelvic mass (84 benign and 44 malignant).
Main Outcome Measures Comparison of self-reported symptoms between ovarian cancer patients
and women seeking care in primary care clinics.
Results In the clinic population, 72% of women had recurring symptoms with a
median number of 2 symptoms. The most common were back pain (45%), fatigue
(34%), bloating (27%), constipation (24%), abdominal pain (22%), and urinary
symptoms (16%). Comparing ovarian cancer cases to clinic controls resulted
in an odds ratio of 7.4 (95% confidence interval [CI], 3.8-14.2) for increased
abdominal size; 3.6 (95% CI, 1.8-7.0) for bloating; 2.5 (95% CI, 1.3-4.8)
for urinary urgency; and 2.2 (95% CI, 1.2-3.9) for pelvic pain. Women with
malignant masses 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 controls. The combination of bloating, increased
abdominal size, and urinary symptoms was found in 43% of those with cancer
but in only 8% of those presenting to primary care clinics.
Conclusions Symptoms that are more severe or frequent than expected and of recent
onset warrant further diagnostic investigation because they are more likely
to be associated with both benign and malignant ovarian masses.