Ovarian cancer – spotting the “silent killer”

Nearly 7,000 women are diagnosed with ovarian cancer every year in the UK, but long-term survival for this disease has changed relatively little over recent decades.  This is mostly due to the fact that the disease is often detected once it is advanced and has spread, making treatment more difficult – hence the nickname “the silent killer”.

If a woman is diagnosed with ovarian cancer at an early stage, she has more than a 7 out of 10 (70 per cent) chance of surviving. But this drops to 15 per cent if she’s diagnosed when the cancer is advanced.

Spotting ovarian cancer earlier would save thousands of lives, but it’s not that simple. The symptoms are vague, and often dismissed by women and GPs as the kind of annoying but accepted “women’s problems” that are commonly linked to ageing, the menopause, or previous pregnancies.

So what can we do to change the picture?

Early detection
One of the most effective tools we have for spotting cancer early is screening, and the national screening programmes for breast, cervical and bowel save thousands of lives.  And screening for ovarian cancer is  a possibility.

Together with the Eve Appeal, we’re funding a study called UKCTOCS, investigating whether a blood test or ultrasound screening can pick up the cancer in its early stages and save lives.  The trial will be running until 2013, so it will be several years until we know whether a national screening programme would work.

But what can we do in the meantime?

Spotting the symptoms
An alternative approach is to take another look at the symptoms of ovarian cancer. Is there a way of sifting through the plethora of vague, non-specific “women’s troubles” to pin down some of the hallmarks of the disease?

That’s what Dr Joan Austoker and her team at the Cancer Research UK Primary Care Education Research Group in Oxford have tried to do in a recent study published in the British Journal of Obstetrics and Gynaecology.

The researchers recruited 124 women who had been referred to hospital clinics with suspected ovarian cancer and interviewed them about their symptoms.  This was (in most cases) before the women had been given a definite diagnosis.  40 of these women were subsequently found to have ovarian cancer (with another 4 suffering other types of cancer), 59 had an illness that turned out not to be cancer, while 21 had nothing seriously wrong with them.

Not a “silent killer” after all
The key finding from this research is that all the women with ovarian cancer had experienced specific symptoms before their diagnosis, and these were different from those who were found not to have cancer. The symptoms included abdominal (tummy) pain, swelling, vaginal bleeding, tiredness and sickness.

But these warning signs weren’t heeded, and were often just put down to weight gain or ageing, leading to delays in going to the doctor.  Many of the women in the study had been having symptoms for some time – a year on average.

Another problem the scientists uncovered was in the words women used to describe their symptoms.  Many women said that they were “bloated” One woman said:

“I’m a size 14 and I went and bought a size 20 skirt last week and it’s not big enough… you feel like you want to stick a pin in it and let loads of air out you know – really bloaty.”

But in medical terms, bloating implies a swelling that fluctuates up and down, whereas in fact these women had significant permanent swelling in their tummy  – a hallmark of ovarian cancer.

So if a GP is told by a woman that she has “bloating”, they should question further, to find out if it is actually persistent swelling.  A simple act, but one that could save lives.

The work also highlights that we need to do more to raise awareness of ovarian cancer symptoms, something that we will be addressing as we push forward with more general work on awareness and early detection. For a start, we’re playing a major role in NAEDI, the National Awareness and Early Detection initiative.

Improving early detection of ovarian cancer will save lives, but we all need to work together – GPs, information providers, and ultimately women themselves.

Kat