Women with ovarian cancer can go undiagnosed for months because their symptoms are not always being investigated without delay.

    Three key symptoms associated with ovarian cancer are identified in the study. They should help clinicians decide whether to investigate further. However, one of these symptoms is not included in current guidance for urgent investigation. 山东大学齐鲁医院妇科张师前

    Accounting for 4 percent of all cancers in women, ovarian cancer has the worst prognosis of all gynecological cancers. In the past, ovarian cancer was thought to have few symptoms and was often dubbed the "silent killer". But recent studies have shown that symptoms are frequent and that their early identification has the potential to improve prognosis.

    Researchers at the University of Bristol set about classifying the key symptoms that could indicate ovarian cancer in women presenting to primary care. They also estimated the positive predictive value for each symptom which is the probability that a woman with a particular symptom actually has ovarian cancer.

    The study involved 212 women aged over 40 with a diagnosis of primary ovarian cancer. It also included 1,060 healthy controls from 39 general practices in Devon, England.

Seven symptoms were associated with ovarian cancer:
• abdominal distension
• urinary frequency
• abdominal pain
• postmenopausal bleeding
• loss of appetite
• rectal bleeding
• abdominal bloating

    Some women presenting with the first three of these symptoms waited at least six months before the diagnosis was made.

    All symptoms had positive predictive values below 1 percent, except for abdominal distension, which had a positive predictive value of 2.5 percent. The authors explain that this means that it carries the highest risk and warrants rapid investigation. Yet persistent abdominal distension is not included in present guidance for urgent investigation. If it were, some women could have their diagnosis speeded up by many months.

   The fact that symptoms are common and often reported is encouraging. This means there is some possibility of identifying early ovarian cancer by using symptoms. "This study provides an evidence base for selection of patients for investigation, both for clinicians and for developers of guidelines".