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Ovarian Cancer: The Neglected Diagnosis


      To investigate presenting signs and symptoms of ovarian cancer and stage of tumor in a community cohort of women with the diagnosis of ovarian cancer.


      We reviewed retrospectively the medical records of all women who sought primary and specialty care in Olmsted County, Minnesota, between January 1, 1985, and December 31, 1997, to evaluate presenting symptoms, time from first symptom to diagnosis of ovarian cancer, and stage of tumor at diagnosis.


      Of 107 women with a diagnosis of ovarian cancer, the most commonly documented presenting symptom was crampy abdominal pain. Urinary symptoms and abdominal pain were the most commonly documented presenting symptom in patients with stage I and II ovarian cancers, whereas abdominal pain and increased abdominal girth were the most commonly documented symptoms in patients with stage III and IV cancer. Approximately 15% of tumors (n=15) were found during routine evaluations or during a procedure for another problem. Less than 25% of presenting symptoms (n=24 women) related directly to the pelvis or were more traditional gynecologic symptoms. Delays in women seeking medical care, health care system issues, competing medical conditions, physicians’ failure to follow up, and women not returning for follow-up were associated with longer time to diagnosis.


      Both stage I and II cancer are associated with symptoms, but few symptoms are directly related to the reproductive pelvic organs or unique to ovarian cancer. A longer interval from first sign or symptom to diagnosis of ovarian cancer is associated with both patient and health care system factors.
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        • Daly M
        • Obrams GI
        Epidemiology and risk assessment for ovarian cancer.
        Semin Oncol. 1998; 25: 255-264
        • Tortolero-Luna G
        • Mitchell MF
        • Rhodes-Morris HE
        Epidemiology and screening of ovarian cancer.
        Obstet Gynecol Clin North Am. 1994; 21: 1-23
        • Beard CM
        • Hartmann LC
        • Atkinson EJ
        • et al.
        The epidemiology of ovarian cancer: a population-based study in Olmsted County, Minnesota, 1935-1991.
        Ann Epidemiol. 2000; 10: 14-23
        • Yawn BP
        • Locke III, GR
        • Lydick E
        • Wollan PC
        • Bertram SL
        • Kurland MJ
        Diagnosis and care of irritable bowel syndrome in a community-based population.
        Am J Manag Care. 2001; 7: 585-592
        • Memarzadeh S
        • Berek JS
        Advances in the management of epithelial ovarian cancer.
        J Reprod Med. 2001; 46: 621-629
        • Rice LW
        • Mark SD
        • Berkowitz RS
        • Goff BA
        • Lage JM
        Clinicopathologic variables, operative characteristics, and DNA ploidy in predicting outcome in ovarian epithelial carcinoma.
        Obstet Gynecol. 1995; 86: 379-385
        • Sato S
        • Yokoyama Y
        • Sakamoto T
        • Futagami M
        • Saito Y
        Usefulness of mass screening for ovarian carcinoma using transvaginal ultrasonography.
        Cancer. 2000; 89: 582-588
        • Miron A
        • Schildkraut JM
        • Rimer BK
        • et al.
        Testing for hereditary breast and ovarian cancer in the southeastern United States.
        Ann Surg. 2000; 231: 624-634
        • Rosenthal A
        • Jacobs I
        Ovarian cancer screening [published correction appears in Semin Oncol. 1998;25:707].
        Semin Oncol. 1998; 25: 315-325
        • MacDonald ND
        • Rosenthal AN
        • Jacobs IJ
        Screening for ovarian cancer.
        Ann Acad Med Singapore. 1998; 27: 676-682
        • Nelson L
        • Ekbom A
        • Gerdin E
        Ovarian cancer in young women in Sweden, 1989-1991.
        Gynecol Oncol. 1999; 74: 472-476
        • Goff BA
        • Mandel LS
        • Melancon CH
        • Muntz HG
        Frequency of symptoms of ovarian cancer in women presenting to primary care clinics.
        JAMA. 2004; 291: 2705-2712
        • Wikborn C
        • Pettersson F
        • Silfversward C
        • Moberg PJ
        Symptoms and diagnostic difficulties in ovarian epithelial cancer.
        Int J Gynaecol Obstet. 1993; 42: 261-264
        • Barber HR
        Ovarian cancer.
        CA Cancer J Clin. 1986; 36: 149-184
        • Gershenson DM
        • Tortolero-Luna G
        • Malpica A
        • et al.
        Ovarian intraepithelial neoplasia and ovarian cancer.
        Obstet Gynecol Clin North Am. 1996; 23: 475-543
        • Smith EM
        • Anderson B
        The effects of symptoms and delay in seeking diagnosis on stage of disease at diagnosis among women with cancers of the ovary.
        Cancer. 1985; 56: 2727-2732
        • Igoe BA
        Symptoms attributed to ovarian cancer by women with the disease.
        Nurse Pract. 1997; 22 (122, 141-144): 127-134
      1. Goff BA, Mandel LS, Muntz HG, Melancon CH. Ovarian cancer diagnosis: results of a National Ovarian Cancer Survey [abstract]. Presented at: the 31st Annual Meeting of the Society of Gynecologic Oncologists; San Francisco, Calif; February 5-9, 2000.

        • Flam F
        • Einhorn N
        • Sjovall K
        Symptomatology of ovarian cancer.
        Eur J Obstet Gynecol Reprod Biol. 1988; 27: 53-57
      2. Moskowitz DB 2000 Health Care Almanac and Yearbook. Faulkner & Gray, New York, NY2000: 210-220
        • Wikborn C
        • Pettersson F
        • Moberg PJ
        Delay in diagnosis of epithelial ovarian cancer.
        Int J Gynaecol Obstet. 1996; 52: 263-267
        • Kurland LT
        • Molgaard CA
        The patient record in epidemiology.
        Sci Am. 1981; 245: 54-63
        • Melton III, LJ
        History of the Rochester Epidemiology Project.
        Mayo Clin Proc. 1996; 71: 266-274
        • Yawn BP
        • Wollan P
        • Klee M
        • Barrette B
        Ovarian carcinoma: care and survival in a community-based population.
        Clin Ther. 2001; 23: 146-159
        • Smith LF
        Research general practices: what, who and why?.
        Br J Gen Pract. 1997; 47: 83-86
        • Chouinard E
        • Walter S
        Recall bias in case-control studies: an empirical analysis and theoretical framework.
        J Clin Epidemiol. 1995; 48: 245-254
        • Paganini-Hill A
        • Ross RK
        Reliability of recall of drug usage and other health-related information.
        Am J Epidemiol. 1982; 116: 114-122
        • Daly KA
        • Lindgren B
        • Giebink GS
        Validity of parental report of a child's medical history in otitis media research.
        Am J Epidemiol. 1994; 139: 1116-1121
        • Stange KC
        • Zyzanski SJ
        • Smith TF
        • et al.
        How valid are medical records and patient questionnaires for physician profiling and health services research? a comparison with direct observation of patients visits.
        Med Care. 1998; 36: 851-867
        • Broder MS
        • Kanouse DE
        • Bernstein SJ
        Assessing symptoms before hysterectomy: is the medical record accurate?.
        Am J Obstet Gynecol. 2001; 185: 97-102
        • Flocke SA
        • Frank SH
        • Wenger DA
        Addressing multiple problems in the family practice office visit.
        J Fam Pract. 2001; 50: 345-352
        • Yancik R
        Ovarian cancer: age contrasts in incidence, histology, disease stage at diagnosis, and mortality.
        Cancer. 1993; 71: 517-523
        • Riva HL
        • Dolan JA
        Differential diagnosis of the acute abdomen.
        Clin Obstet Gynecol. 1972; 15: 484-499
        • Sansone AE
        Ovarian cancer: how to recognize the early symptoms—and save your life.
        Womans Day. October 2001; (Accessed October 19, 2001.): 48
        • Yawn BP
        Clinical decision analysis of HIV screening.
        Fam Med. 1992; 24: 355-361
        • American College of Obstetricians and Gynecologists
        ACOG Committee Opinion: number 280, December 2002: the role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer.
        Obstet Gynecol. 2002; 100: 1413-1416
        • DePriest PD
        • Gallion HH
        • Pavlik EJ
        • Kryscio RJ
        • Van Nagell Jr, JR
        Transvaginal sonography as a screening method for the detection of early ovarian cancer.
        Gynecol Oncol. 1997; 65: 408-414
      3. Schwartz P, Fishman D, Singh D, Lurain J, Cohen L. The role of ultrasound as an independent modality to achieve detection of early stage epithelial ovarian carcinoma [abstract]. Presented at: the Society of Gynecologic Oncologists 34th Annual Meeting on Women's Cancer; New Orleans, La; January 31-February 4, 2003.