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Doctors Identify Possible Early Signs of Ovarian Cancer

June 13, 2007 at 6:40 PM EDT

JIM LEHRER: Finally tonight, earlier detection of ovarian cancer. Jeffrey Brown has our story.

JEFFREY BROWN: It’s among the deadliest of cancers and among the hardest to detect. More than 15,000 women in the U.S. will die from ovarian cancer this year; more than 22,000 new cases will be diagnosed.

When caught early enough, more than 90 percent of patients survive five years or more. But too often, ovarian cancer is not found before it has spread in the body. When detected late, the five-year survival rate drops to just 35 percent.

To promote early detection, three groups of experts today released a list of symptoms they say are warning signs for ovarian cancer. Dr. Barbara Goff is with the Gynecologic Cancer Foundation, one of the three groups involved. Her work at the University of Washington in Seattle helped identify these symptoms.

Dr. Goff, before we discuss the particular findings, tell us a bit more about the problem that’s existed up to now in dealing with ovarian cancer. Why did you need to come up with a list of symptoms?

DR. BARBARA GOFF, Gynecologic Cancer Foundation: Well, historically, ovarian cancer has been called a silent killer, because there weren’t supposed to be any symptoms until advanced stages, when chances of cure were poor or nonexistent. But over the past 10 years, through research of my own and other investigators, we’ve really come to realize that there are some early warning signs of ovarian cancer, and these may give us opportunities to diagnose the disease earlier.

The symptoms, as we’ll talk about, are common symptoms that people have frequently. However, the most recent research has indicated that symptoms that are persistent, symptoms that are new to a patient, may actually provide the clues that we need to make the diagnosis earlier.

JEFFREY BROWN: Well, tell us what the research says. What are the symptoms to look for?

DR. BARBARA GOFF: Well, the most important symptoms are bloating, increased abdominal size, pelvic or abdominal pain or pressure, having difficulty eating, feeling full quickly, and having urinary symptoms, particularly urgency. But as you see, those are symptoms we all have from time to time.

Looking for persistent symptoms

JEFFREY BROWN: Right, as you say, they're fairly common. So how does a woman know if it's significant enough to go see a doctor?

DR. BARBARA GOFF: Well, and that's what the research really has shown, is that it's not simply just having the symptom that is important, but it's that you have a symptom that is new to you. It is a symptom that occurs almost daily or every other day. It is a symptom that persists for more than several weeks and generally gets progressively more severe over time.

JEFFREY BROWN: So if a woman shows those symptoms, you're suggesting she go to the doctor. Do doctors know what to do once a woman comes in, in terms of confirming?

DR. BARBARA GOFF: Well, our recommendation is typically it would be best for a woman to see her OBGYN or her gynecologist, and describe the symptoms, and then, at that point in time, I think certainly most gynecologists know that a pelvic exam should be done. This would include a recto-vaginal exam so that the ovaries can be appropriately felt and then, if needed, appropriate testing, such as a sonogram to take a look at the ovaries, and possibly even a blood test, depending on the results of the sonogram.

JEFFREY BROWN: But to be clear, having the symptoms does not necessarily equate with early stages of ovarian cancer. Is it even the case that most women with these symptoms would prove to have cancer?

DR. BARBARA GOFF: No, in fact, most women, even if they had persistent symptoms, will not have ovarian cancer. It's very similar to breast cancer. Most lumps in the breast are, in fact, not malignant, but we still recommend that, you know, they be evaluated and that that they be biopsied.

And this is true with these symptoms. The majority of the time, there's not going to be ovarian cancer there. But because there's a possibility, and ovarian cancer is such a devastating disease and, in general, you know, with advanced stage disease, has such a poor cure rate, we do want women to understand that these very common symptoms, if they persist and occur almost daily, really could be a sign of something serious.

Treatment involves major surgery

JEFFREY BROWN: So if the test suggests the possibility of cancer, the treatment is quite serious, right? This is major surgery.

DR. BARBARA GOFF: Yes, if the sonogram showed that there was a suspicious ovarian mass, and the blood test showed an elevation of a tumor marker that is common with ovarian cancer, then it would be very important for women to be seen by a gynecologic oncologist or a surgeon who specializes in GYN malignancies, so that the right surgery can be done, and patients can be offered the best chance of cure.

JEFFREY BROWN: But I know that one of the questions raised here is whether the recommendations might lead to unnecessary surgeries, because this is still so imprecise, in terms of knowing precisely, knowing exactly.

DR. BARBARA GOFF: Well, that's always a possibility, but really what we want women to do is, if they have these symptoms, is go in, have the diagnostic test. And if the diagnostic test suggests that there's a problem, then, yes, women probably should have surgery, if there's a suspicion of cancer.

But if the diagnostic tests are normal, which they're going to be in the vast majority of cases, then no surgery would be indicated, and there may be another significant medical reason, you know, for the symptoms. There may be an infection. There may be, you know, other bowel problems. And so these symptoms are common of many medical conditions that also are serious that should be checked out.

Research in screening tests

JEFFREY BROWN: But I assume, for researchers and for doctors, you have a balance yourself here of not trying raise new fears, but to get more information out as early as possible. Is that a fair way of putting it?

DR. BARBARA GOFF: Exactly, exactly. We do not want to scare people, which is why, when we put out this consensus statement indicating, you know, what were the symptoms, we were very clear that it's not simply just having the symptom that is important, but it's the way that symptom presents. It's that the symptom is persistent, that it occurs, you know, on a daily basis.

It's not for somebody who has bloating, you know, for a couple of days and then it goes away. That's not a concerning symptom. But it's the persistent symptom that we really want to get across to women that you need to take that seriously. You should be seen by your doctor and really empower them with this knowledge.

JEFFREY BROWN: And in the meantime, there is still no effective screening test for ovarian cancer?

DR. BARBARA GOFF: Well, there's a lot of research in screening tests for ovarian cancer, and certainly there's a need for funding for more screening tests to develop screening tests for ovarian cancer. But currently, right now, in 2007, we do not have a screening test for ovarian cancer, which is why we say, you know, until there's a test, awareness of this disease really is the best that we can do.

JEFFREY BROWN: All right, so, finally, the take-home message for women listening out there, what would you like them to do?

DR. BARBARA GOFF: I think, if you have symptoms that suggest ovarian cancer, if they are new to you, if they are persistent, they don't go away, you know, after several weeks, then I think the first thing you do is go into your doctor. The overwhelming likelihood is that you're not going to have ovarian cancer, but because it's a possibility, I think it's very important to get it checked out.

JEFFREY BROWN: All right, Dr. Barbara Goff, thank you very much.

DR. BARBARA GOFF: Thank you.