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MONDAY, June 7 (HealthDayNews) -- Ovarian cancer may not be the silent killer it's reputed to be.

A new study has found that, contrary to popular perception, women with early-stage ovarian cancer do experience symptoms. The trick is that they are not gynecologic symptoms and they are similar to what a woman might normally expect to feel over the course of a month or a year.

"The difference was in frequency, severity and duration -- things like bloating, urgency of urination and constipation," said study co-author Lynn Mandel, an educator in the department of obstetrics and gynecology at the University of Washington in Seattle.

A report on the finding appears in the June 9 issue of the Journal of the American Medical Association.

"This is just support of what we've already seen in previous studies: that ovarian cancer is not a disease that is going to shout at you in its early stages. But there is some whispering going on and you have to be listening very carefully," said Dr. Kevin Holcomb, director of gynecologic oncology at Beth Israel Medical Center in New York City.

The information should come as a relief to women and health-care providers alike, many of whom have resigned themselves to believing that ovarian cancer cannot be caught until it is too late.

Early detection for this cancer is critical. When ovarian cancer is detected early, the five-year survival rate is 70 percent to 90 percent, compared to 20 percent to 30 percent for advanced-staged disease.

The study authors surveyed 128 women with ovarian "masses" (either malignant or benign) and 1,709 women who were visiting two primary-care centers about the frequency, severity and duration of symptoms they had experienced over the past year.

In the control group, 72 percent had recurring symptoms of various kinds with a median number of two. The most common complaints were back pain (45 percent), fatigue (34 percent), bloating (27 percent), constipation (24 percent), abdominal pain (22 percent), and urinary symptoms (16 percent).

Compared with the women at the two primary-care clinics, women with ovarian cancer were 7.4 times more likely to have increased abdominal size, 3.6 times more likely to have bloating, 2.5 times more likely to have urinary urgency, and 2.2 times more likely to have pelvic pain. Women with cancerous tumors also experienced symptoms, which tended to be more severe, every day. By contrast, women without cancer might experience symptoms two or three times per month, most often associated with their periods. The combination of bloating, increased abdominal size and urinary symptoms was found in 43 percent of women with cancer but in only 8 percent of those presenting to primary-care clinics.

How do doctors translate this information into saving lives?

Simply having the information in a more general journal, as opposed to a specialized journal, may help primary-care physicians decide who to refer for specialized tests, Holcomb said.

"It takes a careful communication between the doctor and the patient to sort out the symptoms that a woman may be reporting and evaluate them to see who deserves to go on to have an evaluation," said Dr. Mary B. Daly, author of an accompanying editorial and director of cancer prevention and control at Fox Chase Cancer Center in Philadelphia. "This isn't going to take the place of more sophisticated kinds of screening tools that we hope will develop, but even screening tools need to be used in the context of good communications."

More information

Visit the National Cancer Institute for more on ovarian cancer.

(SOURCES: Lynn Mandel, Ph.D., educator, department of obstetrics and gynecology, University of Washington, Seattle; Kevin Holcomb, M.D., director, gynecologic oncology, Beth Israel Medical Center, and assistant clinical professor, obstetrics and gynecology, Columbia University College of Physicians and Surgeons, New York City; Mary B. Daly, M.D., Ph.D., director, cancer prevention and control, Fox Chase Cancer Center, Philadelphia; June 9, 2004, Journal of the American Medical Association)

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