Presenting symptoms of epithelial ovarian cancer.

OBJECTIVES: Epithelial ovarian cancer is a common disease with a high mortality, the latter being frequently attributed to late diagnosis due to failure to recognise symptoms of early disease. This study was designed to determine any differences in symptomatology between patients with early and advanced stage disease.
DESIGN: A retrospective cohort study of 100 patients with stage 1 disease and 100 with stage 3 disease. Ten consecutive patients with stage 1 disease and 10 with stage 3 disease were identified from the database of patients treated each year from 1990 to 1999.
SETTING: A tertiary referral centre for gynecological malignancy. OUTCOME MEASURES: The nature and duration of symptoms, age at presentation, and the size, histologic type and grade of tumour were determined by chart review, and the findings compared using logistic regression analysis.
RESULTS: Ninety percent of women with early, and 100% with advanced disease reported at least one symptom. With early disease, abdominal pain was reported by 51% and abdominal swelling by 32%, and with advanced disease abdominal swelling by 62% and abdominal pain by 44%. Seventy percent of the early stage and 69% of the advanced stage cohorts reported symptoms of less than 3 months duration. Tumours less than 5 cm diameter were three times more likely to have advanced disease (P = 0.02). Grade 1 tumours were 40 times more likely to be early stage than grade 3 tumours. Serous tumours occurred in 25% of patients with early disease, and 45% with advanced disease (P = 0.01).
CONCLUSION: Patients with early stage ovarian cancer are likely to be younger and to have larger, better differentiated tumours that are more often non-serous histologically. Advanced disease is not invariably due to delayed diagnosis.