Ovarian cancer

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Diagnosis

Symptoms

Two case-control studies, both subject to results being inflated by spectrum bias, have been reported. The first found that women with ovarian cancer had symptoms of increased abdominal size, bloating, urinary urgency, and pelvic pain.[1] The smaller, second study found that women with ovarian cancer had pelvic/abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full.[2] The latter study created a symptom index that was considered positive if any of the 6 symptoms "occurred >12 times per month but were present for <1 year".They reported a sensitivity of 57% for early-stage disease and specificity 87% to 90%. In a large validation of the symptom index, the sensitivies were never over 70% whie the specificities were over 90%.[3]

Screening

Screen with annual CA-125 antigen and transvaginal ultrasonography does not reduce mortality according to the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.[4]

Follow-up

Recommendations for the use of the CA-125 antigen in monitoring extent of cancer after treatment have been made by the Gynaecologic Cancer Intergroup (GCIG) and are quoted below by Goonewardene et al:[5]

  • patients with increased pretreatment CA-125 concentrations, which later normalise, need to show evidence of a
    • CA-125 concentration greater than, or equal to, two-times the upper normal limit on two occasions at least 1 week apart;
  • patients with increased pretreatment CA-125 concentrations, which never normalise, need to show evidence of
    • CA-125 concentrations greater than, or equal to, two-times the nadir value on two occasions at least 1 week apart; or
  • patients with CA-125 concentrations in the normal range pretreatment need to show evidence of
    • CA-125 concentrations greater than, or equal to, two-times the upper normal limit on two occasions at least 1 week apart.

References

  1. Goff BA, Mandel LS, Melancon CH, Muntz HG (2004). "Frequency of symptoms of ovarian cancer in women presenting to primary care clinics". JAMA 291 (22): 2705-12. DOI:10.1001/jama.291.22.2705. PMID 15187051. Research Blogging. PMID 15187051
  2. Goff BA, Mandel LS, Drescher CW, et al (2007). "Development of an ovarian cancer symptom index: possibilities for earlier detection". Cancer 109 (2): 221-7. DOI:10.1002/cncr.22371. PMID 17154394. Research Blogging. PMID 17154394
  3. Rossing, Mary Anne; Kristine G. Wicklund, Kara L. Cushing-Haugen, Noel S. Weiss (2010-01-28). "Predictive Value of Symptoms for Early Detection of Ovarian Cancer". J. Natl. Cancer Inst.: djp500. DOI:10.1093/jnci/djp500. Retrieved on 2010-01-29. Research Blogging.
  4. Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C et al. (2011). "Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial.". JAMA 305 (22): 2295-303. DOI:10.1001/jama.2011.766. PMID 21642681. Research Blogging.
  5. Goonewardene TI, Hall MR, Rustin GJ (2007). "Management of asymptomatic patients on follow-up for ovarian cancer with rising CA-125 concentrations.". Lancet Oncol 8 (9): 813-21. DOI:10.1016/S1470-2045(07)70273-5. PMID 17765190. Research Blogging.