Doctors, Patients Should Discuss, Investigate Vague Symptoms
WebMD Health News
June 8, 2004 -- New research sheds light on symptoms of ovarian
cancer, often referred to as a "silent killer." A cluster of symptoms --
increased bloating and abdominal size, pressure to urinate, constipation, and abdominal
pain -- should not be overlooked, say study authors.
"Women need to be aware of this cluster [of symptoms],"
researcher Lynn S. Mandel, PhD, with the department of obstetrics and
gynecology at the University of Washington in Seattle. "It doesn't mean they
have ovarian cancer. But the symptoms
should be investigated to see what it is. It could be a malignancy, or it could
be something else -- an ovarian cyst or endometriosis."
Mandel's study, which appears in this week's Journal of the
American Medical Association, should also be a wake-up call for doctors,
says Ira Horowitz, MD, vice chairman and director of gynecologic oncology at
Emory University's Winship Cancer Institute in Atlanta.
"Ovarian cancer is very silent in the early stages ...
any symptoms are usually vague, nonspecific, and doctors tend to blow them
off," Horowitz tells WebMD. "This study tells us that we need to heed those
vague symptoms. They are screaming for our attention. We need to think of
ovarian cancer first -- not last."
Indeed, many women see numerous doctors for their symptoms,
including gastrointestinal specialists, before ovarian cancer is even
suspected. And, unfortunately, the symptoms are most noticeable when cancer is
advanced -- not in the early stages, Horowitz tells WebMD. "When the
mass [in the ovary] is significant in size, that's when symptoms are more
intense. Then it's too late."
It all points to the need for better -- and ongoing --
doctor-patient communication, writes Mary B. Daly, MD, PhD, in an accompanying
editorial. "The early diagnosis of ovarian cancer must rely on the elusive
practice of [the doctor's] judgment ... and thoughtful dialogue between patient
"Women know their bodies, and when something changes, they need
to make sure the physician is aggressive in evaluating it," Horowitz says.
Ovarian cancer has long frustrated doctors and their patients,
writes Mandel. Very few cases of ovarian cancer are caught in the early
treatable stages -- and chances of surviving late-stage ovarian cancer is
The reason: There has been no clear pattern of symptoms. For
many women, the symptoms are so common and vague that they don't realize
anything is wrong. In fact, not all women even have symptoms.
Mandel's research group and others have attempted to unravel
this mystery. In an earlier study, her group found a pattern of
gastrointestinal and abdominal problems, pain, fatigue, and urinary
difficulties that seemed fairly predictable.
This new study attempts to pinpoint the pattern more closely.
The survey asked about a variety of symptoms that are often dismissed as
unimportant: pelvic, abdominal, and back pain; indigestion;
bloating and increased abdomen size; urinary and bowel problems, menstrual
problems, and problems during intercourse (like pain or bleeding); and fatigue
and leg swelling.