Early detection of ovarian cancer

Abstract

For years, Dr. Goff and colleagues have carried the banner for getting physicians to recognize that early stage ovarian cancer causes symptoms for months before diagnosis. For this they deserve accolades from gynecologists and primary care physicians, and appreciation from all the women we serve.In this issue of Cancer, Goff et al report the results from a survey that was mailed to 3200 primary care physicians (gynecologists, family physicians, and internists). 1 The respondents declared which tests they would order to evaluate patients who presented with various symptoms. The outcome measure was the proportion of physicians ordering the tests that would detect ovarian cancer: ultrasound, pelvic computed tomography (CT), and cancer antigen 125 (CA 125). The data essentially demonstrate that these physician groups have gotten the message: ''Do not forget that early ovarian cancer causes symptoms.'' This is a remarkable change in dogma. Before this knowledge, how many times had we explained to our patients with advanced ovarian cancer that we could not have made the diagnosis earlier; that the cancer already had metastasized by the time the patient had reported abdominal distension, bloating, and early satiety?Some remarkable data emerge from this study. Nearly 90% of physicians reported that they would recommend at least 1 of the appropriate diagnostic tests; 71% chose an ultrasound, which, in my opinion, is the test most likely to indicate the risk of malignancy. This high rate of appropriate clinical management reflects positively on the efforts of Dr. Goff and others who have published on the symptoms of early stage ovarian cancer. Developing an educational process to improve this outcome would be very difficult.Another encouraging finding was that gynecologists were more likely than other primary care groups to order the appropriate tests. The authors adequately explain that this is because of the core education of gynecology, which includes ovarian malignancies. Nevertheless, the appropriate response rates for family physicians and internists still were outstanding: 88% for both.Less impressive findings of this study are the statistically significant but clinically insignificant outcomes. The large number of respondents enabled small differences to be statistically significant. The ''adjusted'' risk ratios of 1.07 (urologic [GU] vs gastrointestinal [GI] symptoms), 1.06 (group practice vs solo practitioner), and 1.04 (clinical teaching, yes or no) were all statistically significant, but a 4% to 7% relative difference in these variables does not seem to have much practical clinical value. For example, both GI symptoms and GU symptoms triggered excellent responses for ordering appropriate tests, 86% and 92%, respectively, a statistically significant difference. In my opinion, this 6% difference is relatively minor and should not overshadow the positive tribute that the vast majority of physicians would make the diagnosis of ovarian cancer in women presenting with either GI or GU symptoms.Dr. Goff and colleagues...

Rare but Still There: A Scoping Review on Endometriosis-Associated Ovarian Cancer

“…About 25% of all ovarian cancers are detected at an early stage (stage I) and this might be due to the presence of certain specific signs and symptoms [76]. There are a few case studies which describe the presentation of patients with EAOC.…”

Characterization of Cancer/Testis Antigens as Prognostic Markers of Ovarian Cancer

“…Currently, treatment options for ovarian cancer are predominantly limited to surgery, radiotherapy, and chemotherapy. Due to the difficulty of achieving an early diagnosis, postoperative tumor recurrence, and late chemotherapy resistance, the 5-year survival rate of advanced ovarian cancer is less than 30% [2]. Hence, there is an urgent need to explore new avenues for early diagnosis, prognosis, and targeted therapy for ovarian cancer.…”

LNPEP as a Prognostic-Related Biomarker in Ovarian Cancer Correlating with Immune Infiltrates

“…Despite the development of signi cant advancements to facilitate early diagnosis and treatment of OV, the 5-year survival rate still falls only around 47% [3]. OV has been termed the "silent killers" of women [4]. As a result of insu cient speci c clinical manifestations and effective early detection, the majority of patients suffer from the late intermediate local stage [5].…”