Ovarian cancer is the second most common gynecologic malignancy and the most common cause of death among women with gynecologic cancer . This poor prognosis is due, in large part, to the fact that most women are diagnosed at an advanced stage, while early stages of the disease are potentially curable. Unfortunately, attempts to develop screening programs for epithelial ovarian cancer using pelvic imaging or tumor markers have not yet been successful. The identification of epithelial ovarian cancer symptoms to aid early detection has become a focus of clinical research.
Epithelial carcinoma of the ovaries, fallopian tubes, and peritoneum are clinically similar. Evidence suggests that these diseases have a common pathogenesis, and may be initiated in the fallopian tubes. The term ovarian cancer will be used in this topic to refer to disease of any of these three sites.
Early detection of epithelial ovarian cancer through symptoms recognition is reviewed here. Screening and diagnosis of epithelial ovarian cancer are discussed separately. (See "Screening for ovarian cancer" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)
EVIDENCE REGARDING EARLY SYMPTOMS
Presence of early symptoms — Historically, epithelial ovarian cancer was called the "silent killer" because symptoms were not thought to occur until very late in the course of the disease . Advanced epithelial ovarian cancer typically presents with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases; dyspnea is occasionally present due to a pleural effusion. However, studies have found that symptoms occur in many women even at early stages of the disease [3-8].
Most women with epithelial ovarian cancer have pelvic or abdominal symptoms prior to their diagnosis. This was demonstrated in a meta-analysis that included 21 mostly retrospective studies (one study was prospective) of women with epithelial ovarian cancer . The proportion of women report symptoms differed by study design (7 percent were asymptomatic by patient interview or questionnaire; 23 percent according to medical records). This difference is likely due to recall bias in the patient report studies.