Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer

Webb, Penelope M.; Purdie, David M.; Grover, Sonia; Jordan, Susan J.; Dick, Marie–Louise; Green, Adèle C.

doi:10.1016/j.ygyno.2003.09.005

Cited by 75 publications

(67 citation statements)

References 18 publications

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“…Our patient and diagnostic intervals are comparable to those previously reported (medians between 1 and 4 months) 10, 12, 14, 34. Also in corroboration of our findings, a large population‐based case–control study in Australia reported no difference in time‐to‐diagnosis intervals for early‐ versus late‐stage iEOC 6.…”

Section: Discussionsupporting

confidence: 91%

Time to diagnosis of Type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records

Lim

Mesher

Gentry‐Maharaj

et al. 2015

BJOG

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ObjectiveTo compare time to diagnosis of the typically slow‐growing Type I (low‐grade serous, low‐grade endometrioid, mucinous, clear cell) and the more aggressive Type II (high‐grade serous, high‐grade endometrioid, undifferentiated, carcinosarcoma) invasive epithelial ovarian cancer (iEOC).DesignMulticentre observational study.SettingTen UK gynaecological oncology centres.PopulationWomen diagnosed with primary EOC between 2006 and 2008.MethodsSymptom data were collected before diagnosis using patient questionnaire and primary‐care records. We estimated patient interval (first symptom to presentation) using questionnaire data and diagnostic interval (presentation to diagnosis) using primary‐care records. We considered the impact of first symptom, referral and stage on intervals for Type I and Type II iEOC.Main outcome measuresPatient and diagnostic intervals.ResultsIn all, 78% of 60 Type I and 21% of 134 Type II iEOC were early‐stage. Intervals were comparable and independent of stage [e.g. median patient interval for Type I: early‐stage 0.3 months (interquartile range 0.3–3.0) versus late‐stage 0.3 months (interquartile range 0.3–4.5), P = 0.8]. Twenty‐seven percent of women with Type I and Type II had diagnostic intervals of at least 9 months. First symptom (questionnaire) was also similar, except for the infrequent abnormal bleeding (Type I 15% versus Type II 4%, P = 0.01). More women with Type I disease (57% versus 41%, P = 0.04) had been referred for suspected gynaecological cancer. Median time from referral to diagnosis was 1.4 months for women with iEOC referred via a 2‐week cancer referral to any specialty compared with 2.6 months (interquartile range 2.0–3.7) for women who were referred routinely to gynaecology.ConclusionOverall, shorter diagnostic delays were seen when a cancer was suspected, even if the primary tumour site was not recognised to be ovarian. Despite differences in carcinogenesis and stage for Type I and Type II iEOC, time to diagnosis and symptoms were similar. Referral patterns were different, implying subtle symptom differences. If symptom‐based interventions are to impact on ovarian cancer survival, it is likely to be through reduced volume rather than stage‐shift. Further research on histological subtypes is needed.Tweetable abstractNo difference in time to diagnosis for Type I versus Type II invasive epithelial ovarian cancers.

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Section: Discussionsupporting

confidence: 91%

Time to diagnosis of Type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records

Lim

Mesher

Gentry‐Maharaj

et al. 2015

BJOG

View full text Add to dashboard Cite

show abstract

“…There have been several studies refuting the suggestion that delay in diagnosis is responsible for the advanced disease. 2,13,17,18 In these studies, women with early stage disease reported similar or rather longer duration of symptoms, indicating there may be significant biological differences between the early and advanced stages. Nevertheless, Goff's symptom index is meaningful in that it made patients and clinicians aware of specific symptoms as early alarm.…”

Section: 10mentioning

confidence: 70%

“…[2][3][4][5][6] The symptoms most commonly seen are abdominal or gastrointestinal in nature, whereas gynecologic symptoms, such as abnormal vaginal bleeding or menstrual irregularities, were reported by less than 25% of patients. 5,13,14 These symptoms tend to be more constant and of more recent onset. With accumulating evidences, finally in 2007, several US organizations, including patient groups, released a consensus statement on the symptoms of ovarian cancer.…”

Section: 10mentioning

confidence: 99%

A hospital-based case-control study of identifying ovarian cancer using symptom index

Kim

et al. 2009

J Gynecol Oncol

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Objective: Recently, a symptom index for identification of ovarian cancer, based on specific symptoms along with their frequency and duration, was proposed. The current study aimed at validation of this index in Korean population. Methods: A case-control study of 116 women with epithelial ovarian cancer and 209 control women was conducted using questionnaires on eight symptoms. These included pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, difficulty eating/feeling full. The symptom index was considered positive if any of the 8 symptoms present for ＜1 year that occurred＞12 times per month. The symptoms were compared between ovarian cancer group and control group using chi-square test. Logistic regression analysis was used to determine whether the index predicted cancer. Sensitivity and specificity of the symptom index were also determined. Results: The symptom index was positive in 65.5% of women with ovarian cancer, in 31.1% of women with benign cysts, and in 6.7% of women on routine screening (ps＜0.001). Significantly higher proportion of ovarian cancer patients were positive for each symptom as compared with control group (ps＜0.001). Results from the logistic regression indicated that the symptom index independently predicted cancer (p＜0.001; OR, 10.51; 95% CI, 6.14 to 17.98). Overall, the sensitivity and specificity of the symptom index were 65.5% and 84.7%, respectively. Analyses of sensitivity by stage showed that the index was positive in 44.8% of patients with stage I/II disease and in 72.9% of patients with stage III/IV disease. Conclusion: The current study supported previous studies suggesting that specific symptoms were useful in identifying women with ovarian cancer.

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“…Presentation of ovarian cancer in advanced stages is straightforward (Webb et al, 2004). However in cases of early stages, diagnosis is difficult as they present with vague complaints.…”

Section: Introductionmentioning

confidence: 99%

Pre-Operative Evaluation of Ovarian Tumors by Risk of Malignancy Index, CA125 and Ultrasound

Arun-Muthuvel¹,

Vijayaraghavan²

2014

Asian Pacific Journal of Cancer Prevention

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Purpose: To evaluate the diagnostic performances of risk of malignancy index (RMI), CA-125 and ultrasound score in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostic test for referral of suspected malignant ovarian cases to gynaecologic oncologists. Materials and Methods: This prospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July 2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnostic values of each parameter and the RMI were determined and compared using Statistical Packages for Social Sciences Version 14.0.1. Results: In our study, 61% of ovarian tumors were malignant in the post-menopausal age group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer. CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivity of 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies. Ultrasound when used individually had the best sensitivity but poor specificity. Conclusions: Our study has demonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients with pelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist. Other models of preoperative evaluation should be developed to improve the detection of early stage invasive, borderline and non-epithelial ovarian cancers.

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Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer

Cited by 75 publications

References 18 publications

Time to diagnosis of Type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records

Time to diagnosis of Type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records

A hospital-based case-control study of identifying ovarian cancer using symptom index

Pre-Operative Evaluation of Ovarian Tumors by Risk of Malignancy Index, CA125 and Ultrasound

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