Ovarian cancer: the neglected diagnosis.
OBJECTIVE
To investigate presenting signs and symptoms of ovarian cancer and stage of tumor in a community cohort of women with the diagnosis of ovarian cancer.


METHODS
We reviewed retrospectively the medical records of all women who sought primary and specialty care in Olmsted County, Minnesota, between January 1, 1985, and December 31, 1997, to evaluate presenting symptoms, time from first symptom to diagnosis of ovarian cancer, and stage of tumor at diagnosis.


RESULTS
Of 107 women with a diagnosis of ovarian cancer, the most commonly documented presenting symptom was crampy abdominal pain. Urinary symptoms and abdominal pain were the most commonly documented presenting symptom in patients with stage I and II ovarian cancers, whereas abdominal pain and increased abdominal girth were the most commonly documented symptoms in patients with stage III and IV cancer. Approximately 15% of tumors (n = 15) were found during routine evaluations or during a procedure for another problem. Less than 25% of presenting symptoms (n = 24 women) related directly to the pelvis or were more traditional gynecologic symptoms. Delays in women seeking medical care, health care system issues, competing medical conditions, physicians' failure to follow up, and women not returning for follow-up were associated with longer time to diagnosis.


CONCLUSIONS
Both stage I and II cancer are associated with symptoms, but few symptoms are directly related to the reproductive pelvic organs or unique to ovarian cancer. A longer interval from first sign or symptom to diagnosis of ovarian cancer is associated with both patient and health care system factors.
Yawn
Barbara P
BP
Department of Research, Olmsted Medical Center, 210 Ninth St SE, Rochester, MN 55904, USA. yawnx002@umn.edu
Barrette
Brigitte A
BA
Wollan
Peter C
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population