Clinical Presentation Symptoms

The symptoms of ovarian cancer are vague and commonly occur in benign conditions. Patients with ovarian cancer often present late and are diagnosed at an advanced stage. In early-stage disease, patients may present with common gynecologic symptoms such as vaginal bleeding or discharge. Urinary frequency or constipation may be the result of compression of the bladder or rectum. Patients at all stages may present with abdominal pain and distention. Gastrointestinal symptoms such as nausea, anorexia, early satiety, and abdominal bloating are usually associated with advanced-stage disease and are related to ascites and peritoneal carcinomatosis44 (Table 1-5). In a study by Olson and colleagues, 45 nearly all patients (93%) reported

Table 1-5.

Symptoms Most Commonly Associated with Ovarian Cancer

All Symptoms Reported (%)

First Symptom Reported (%)

Borderline

Invasive Stage Invasive Stage

Borderline

Invasive Stage

Invasive Stage

(n = 146)

I—II {p = 218)

III—V (n = 447)

Z2 test

lp = 146)

I—II (n = 218)

III—IV (f? = 447)

f test

Gynecologic symptoms

15.5

15.4

9.5

P = .03

9.8

10.4

6.5

P= .1

Abdominal symptoms

80.5

78.2

78.1

P = .6

72.4

64.4

66.1

P= .3

Pain or pressure

43.9

46.0

42.6

P = .7

39.0

34.2

34.0

P= .6

Swelling or tightening

42.3

31.2

40.9

P = .04

23.6

18.3

25.4

P= .1

Mass

13.0

19.3

8.8

P = .0009

9.8

11.9

6.5

P= .07

Gastrointestinal symptoms

11.4

11.9

17.9

P = .03

6.5

7.9

10.7

P= .1

Urinary/bladder symptoms

4.9

11.4

5.6

P= .02

3.3

6.9

3.7

P= .1

General malaise

4.9

9.4

13.0

P = .008

4.1

5.9

6.3

P= .1

Other symptoms

5.7

7.4

9.8

P = .1

4.1

4.5

6.5

P= .1

From Webb PM, Purdie DM, Grover S, et al: Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer. Gynecol Oncol 92(1)232-239, 2004.

CD CO CD

From Webb PM, Purdie DM, Grover S, et al: Symptoms and diagnosis of borderline, early and advanced epithelial ovarian cancer. Gynecol Oncol 92(1)232-239, 2004.

at least one symptom. The most common symptoms are abdominal bloating, fullness, and pressure (71%). Other symptoms included abdominal or lower back pain (52%), lack of energy (43%), frequent urination, urgency or burning (33%), constipation (21%), decreased appetite (20%), and nausea (13%). If the disease has progressed to involve the lungs, as exemplified by the presence of pulmonary metastasis or malignant pleural effusions, the patient may present with complaints of shortness of breath.

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