Ovarian cancer is not a symptomless killer

Ovarian cancer is not the symptom free disease that many medical textbooks have been claiming for years, says an Editorial in this week's edition of The Lancet.

The Editorial says: "Far from its historic portrayal as a silent killer, ovarian cancer is preceded by symptoms, as recent evidence shows. Women who are ultimately diagnosed with the disease, and usually at a late stage, say that they did have symptoms, primarily gastrointestinal or urinary, for three to four months on average before diagnosis."

Because of these delays in diagnosis, patient groups have pressed for education about early symptoms among women and doctors. Several US organisations have released a consensus statement, urging women to seek medical attention if they have new and persistent symptoms of bloating, pelvic or abdominal pain, difficulty eating or early satiety, and urinary urgency or frequency.

The Editorial accepts that such symptoms can be vague and related to other conditions, but adds that anything which leads to greater awareness of ovarian cancer is commendable. It says: "On the other hand, the [consensus] statement provides no specific guidance about what to do when such women present to them; the need for the challenging art of clinical judgement remains acute."

It adds: "There is no evidence whatever that detection based on these factors will substantially shift diagnosis early enough to affect mortality."

Despite its considerable limitations, the Editorial supports the consensus statement. It concludes: "The statement is a move in the right direction. Its chief contribution might be to improve communication between women and their doctors. To maximise its chance of success, it ought to be combined with other efforts, especially increased funding for ovarian cancer research, which has been declining for the past several years; large prospective trials of early detection methods; ongoing education and awareness campaigns for the public and professionals; and development of standardised diagnostic algorithms for the disease."