A cluster of three common symptoms in women - a swollen abdomen, a bloated feeling and urgent urination - should raise suspicions of ovarian cancer if they are persistent, severe and began recently, a study says.
The three symptoms are among many that have been associated with ovarian cancer before. But because they also affect most healthy women at some point in their lives, they are often not seen as a tip-off to cancer.
The lack of clearly identifiable symptoms has contributed to the relatively poor prognosis for women with ovarian cancer.
While cure rates are high when the disease is detected early, about 75 percent of women are diagnosed when the cancer is in advanced stages.
Nearly 26,000 U.S. women will be diagnosed with ovarian cancer this year and more than 16,000 will die from it, the American Cancer Society estimates.
The new study may help narrow the list of symptoms that might signal a need for further tests, said lead author Dr. Barbara Goff, a gynecologic cancer specialist at the University of Washington.
All three symptoms were found in 43 percent of women later diagnosed with ovarian cancer, but in just 8 percent of women without the disease.
Women with ovarian cancer also were more likely than others to report that symptoms began within the preceding several weeks rather than several months or years earlier. Their symptoms also were more likely to be severe and to occur as often as every day or most days.
The cluster of symptoms occurred in women with early-stage disease and in those with more advanced cases. They also occurred in women who had non-cancerous ovarian tumors, so their presence did not necessarily signal a dire diagnosis, Goff said.
The study appears in Wednesday's Journal of the American Medical Association.
The study helps explode the myth that ovarian cancer is a silent killer, said Dr. Ed Partridge, a gynecologic cancer specialist at the University of Alabama at Birmingham. Even women in early stages of the disease had symptoms, he said.
Doctors who suspect ovarian cancer often order ultrasound or blood tests first. But the only definitive way to diagnose the disease is surgery.
The three symptoms, if recent and persistent, should indicate to doctors that these women "have to be evaluated instead of just giving them relief for bloating or saying, `That's normal,''' said Dr. Carmen Rodriguez of the American Cancer Society.
The study is based on surveys of 1,709 cancer-free women and 128 women awaiting surgery for pelvic tumors including ovarian cancer.
A JAMA editorial said the study still leaves doctors uncertain about exactly when to order diagnostic tests. Testing only women with the three symptoms cited would still miss a considerable number of women with cancer, Drs. Mary Daly and Robert Ozols of Fox Chase Cancer Center in Philadelphia wrote.
"Based on these data, there is no way to avoid the conclusion that early diagnosis of ovarian cancer must rely on the elusive practice of clinical judgment,'' they said.