title: Frequency of symptoms of ovarian cancer in women presenting to primary care clinics.
abstract: BACKGROUND
  Women with ovarian cancer frequently report symptoms prior to diagnosis, but distinguishing these symptoms from those that normally occur in women remains problematic.
  
  
  OBJECTIVE
  To compare the frequency, severity, and duration of symptoms between women with ovarian cancer and women presenting to primary care clinics.
  
  
  METHODS
  A prospective case-control study of women who visited 2 primary care clinics (N = 1709) and completed an anonymous survey of symptoms experienced over the past year (July 2001-January 2002). Severity of symptoms was rated on a 5-point scale, duration was recorded, and frequency was indicated as number of episodes per month. An identical survey was administered preoperatively to 128 women with a pelvic mass (84 benign and 44 malignant).
  
  
  METHODS
  Comparison of self-reported symptoms between ovarian cancer patients and women seeking care in primary care clinics.
  
  
  RESULTS
  In the clinic population, 72% of women had recurring symptoms with a median number of 2 symptoms. The most common were back pain (45%), fatigue (34%), bloating (27%), constipation (24%), abdominal pain (22%), and urinary symptoms (16%). Comparing ovarian cancer cases to clinic controls resulted in an odds ratio of 7.4 (95% confidence interval [CI], 3.8-14.2) for increased abdominal size; 3.6 (95% CI, 1.8-7.0) for bloating; 2.5 (95% CI, 1.3-4.8) for urinary urgency; and 2.2 (95% CI, 1.2-3.9) for pelvic pain. Women with malignant masses typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or controls. The combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of those with cancer but in only 8% of those presenting to primary care clinics.
  
  
  CONCLUSIONS
  Symptoms that are more severe or frequent than expected and of recent onset warrant further diagnostic investigation because they are more likely to be associated with both benign and malignant ovarian masses.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle 98195, USA. bgoff@u.washington.edu
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Mandel
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Melancon
authors.forename: Howard G
authors.initials: HG
authors.lastname: Muntz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires