Common pelvic nuisances can signal early ovarian cancer
By CHERYL CLARK Copley News Service

The recent warning that bloating and three other common pelvic nuisances could signal early stage ovarian cancer might cause many women to panic.

That's not the intent, said Dr. Barbara Goff, an ovarian cancer researcher who helped write the controversial advisory. Goff's research suggests that if doctors pay more attention to these four symptoms, they might catch many more cases of ovarian cancer. Threequarters of ovarian cancers are diagnosed after the disease has reached its late stage, when a cure is much less likely.

"There have been so many women who complained about these symptoms but were blown off by their doctors," said Goff, a gynecologic oncologist at the University of Washington. "We now know that paying attention could mean the difference between a 70 to 90 percent chance of a cure at stage 1, versus 20 to 30 percent at stage 4."

But the effectiveness of the advisory remains unclear for patients. It has spurred disagreement among physicians, some of whom doubt the recommendations will save lives.

The concerns are based on questions such as:

- Are the symptoms vague?

- Is there enough evidence that they could be early indications of ovarian cancer?

- Will the recommendations cause women to worry unnecessarily, or will they lead to quicker detection of ovarian cancer and result in higher rates of survival?

- Will doctors take time to conduct appropriate exams and refer patients to qualified specialists?

- Will vaginal ultrasounds and other tests give some women false positives and send them into needless treatment?

- Will insurance companies and Medicare cover the cost of additional office visits and tests?

The advisory lists four symptoms: bloating, pelvic or abdominal pain, frequent or difficult urination, and feeling full quickly or having difficulty eating.

Women who have one or more of these complaints with no apparent cause, and who experience them nearly every day for at least two weeks, should be examined by a doctor, preferably a gynecologist.

The recommendations were issued June 14 by a panel representing the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.

Those groups said there's increasing evidence that when the four symptoms occur persistently, they are much more likely to appear in women with ovarian cancer than in the general population.

Other symptoms linked to ovarian cancer - such as fatigue, indigestion, back pain, menstrual irregularities and pain during intercourse - are as common in healthy people.

The panel urged physicians to conduct proper vaginal-rectal exams to find suspicious ovarian growths. If a finding is unclear, the doctors could order pelvic ultrasound imaging and a blood test called CA-125. However, CA-125 is unreliable because it measures a substance often associated with other conditions.

Positive findings might prompt a biopsy to confirm diagnosis of ovarian cancer. Early treatment includes surgery and chemotherapy when the tumor is small and isolated.

In general, doctors agree that more publicity about ovarian cancer is badly needed.

But many physicians believe the symptoms listed in the advisory are common among women of all ages. Some of the conditions are transitory and harmless. Others may be chronic, perhaps linked to problems such as acid reflux disease or urinary tract infections.

Physicians and patients are especially frustrated with ovarian cancer because they still have no reliable screening tool for the disease.

"The confusion and anxiety about what to make of this kind of proclamation is wellfounded," said Dr. Mark Adler, director of the San Diego Cancer Center in Encinitas and Vista, Calif. "It points to our lack of objective screening for ovarian cancer."

Some doctors think the recommendations should be trumpeted from the rooftops.

"The biggest obstacle is that individual physicians not experienced in cancer are very likely to dismiss these complaints," said Dr. Albert Deisseroth, an avid supporter of the advisory. He's president and chief executive of the Sidney Kimmel Cancer Center in San Diego County.

Deisseroth said that too often, patients complain about abdominal bloating and have their doctors respond, "Oh don't worry, we'll give you antibiotics."

In contrast, certain physicians think the recommendations are bound to be misapplied.

"This isn't going to save any lives" because the symptoms are far too vague, said Dr. Philip Young, a gynecologist in Vista, Calif.

In addition, he and other physicians insist that even if the symptoms do signal ovarian cancer, the disease has probably reached an advanced stage by then.

"What this will do is create a lot of anxiety because the majority of women will have something else or nothing at all," Young said.

Dr. Allan Bombard, chief medical officer at Sharp Mary Birch Hospital in San Diego, said his feelings about the recommendations are mixed.

He would wait for the symptoms to last through a menstrual cycle and would put heavy weight on a woman's family history of ovarian or breast cancer.

While catching ovarian cancer earlier would be a good thing, Bombard said, overtesting women can cause various inconveniences, anxiety and financial hardship.

Even an official for the American Cancer Society is skeptical about implementing the advisory.

"Probably a very small number (of women with these symptoms) will turn out to have ovarian cancer," said Dr. Len Lichtenfeld, the organization's deputy chief medical officer in Atlanta. "There may be overtesting, and some harm that comes from overtesting. We can't yet put the relative weight on the benefits versus the harm."

But Goff also pointed to recent research showing that ovarian cancer patients were far more likely than other women to have complained of bloating, fullness and pressure in the abdomen between six and 12 months before their diagnosis.

The research includes a May study from the Centers for Disease Control and Prevention. That report said more than 81 percent of women diagnosed with early-stage ovarian cancer had at least one target symptom, such as pelvic swelling, before diagnosis.

Citing her own research, Goff said ovarian cancer patients who complained of the pelvic symptoms often were told that nothing was wrong or that they had everything from depression to irritable bowel syndrome.

Only 20 percent of those patients were initially informed that they might have ovarian cancer.

Geri Danzig of San Diego is a classic case.

When she complained about her pelvic symptoms to two doctors, she first was given an anti-depressant. "Then I was told I had fibroids," Danzig recalled.

When her stomach developed spasms in April 2006, she went to an emergency room. There, she was finally diagnosed with late-stage ovarian cancer.

Danzig has endured major surgery and chemotherapy and is working hard to recover.

"I'm glad there's finally publicity about this disease," said Danzig, 64. "I only wish it were adamant, stressing the need for more research to find a way to diagnose this killer disease sooner."