Diagnosing Ovarian Cancer: Does it matter when

Friday, June 10, 2011
More often than not, ovarian cancer is diagnosed at an advanced stage. That's because by the time the cancer has caused symptoms, it has usually had the opportunity to grow beyond the confines of the ovary, and to involve the bowels (causing constipation and pain) or even the lung (causing fluid which presents as difficulty breathing). While prior studies demonstrated that there are signs of ovarian cancer (bloating, abdominal or pelvic pain, difficulty eating or feeling full quickly, or urinary urgency or frequency) it has not been entirely clear whether earlier detection is associated with improved outcomes. To address this issue, Christina Nagle and colleagues studied 1318 women with ovarian cancer diagnosed and treated in Australia (1). They found that 55% were diagnosed within 1 month of presenting with symptoms, 70% by 2 months, and 92% within 6 months. There were no differences identified in the time from the onset of symptoms to the time of medical visit or in the time of symptoms to diagnosis between those ultimately diagnosed with early versus late disease. More surprisingly, though, is that there was no difference between time to diagnosis and overall survival, suggesting that once disease is symptomatic the time to diagnosis is not an important mediator of outcome.

The sobering conclusion of this research emphasizes the work still needed to enable providers to make an earlier diagnosis. Indeed, preventing ovarian cancer using CA-125 based algorithms and basic research in to the pathogenesis of ovarian cancer continue to be active areas of research.

For me, the main point in this article is that women with ovarian cancer should never feel guilty if they are diagnosed with advanced disease; according to this article, presentation later affords no prognostic significance. This is NOT to say that women or their providers should delay or defer evaluation if symptoms are present. While time to diagnosis may not be associated with outcome, surgical result is, and thus, the more advanced disease is the harder it may be to remove all of it, or to get women to a "completely resected" or "optimally resected" point.

I look forward to the day when ovarian cancer early detection becomes a reality. Until then, we must do what we can to listen to our bodies and to investigate when something awry occurs. Updates in prevention, diagnosis, surgical and medical treatment have increased the life expectancy of women with this disease and it requires a collaboration between primary care providers, patients, medical and gynecologic oncologists to ensure the best for each one of our patients.

1. C Nagle, et al. JCO 2011; Published online May 2, 2011.

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