title: Identifying symptoms of ovarian cancer: a qualitative and quantitative study.
abstract: BACKGROUND
  Symptoms of ovarian cancer are often vague and consequently a high proportion of women with ovarian cancer are not referred to the appropriate clinic.
  
  
  OBJECTIVE
  To identify diagnostic factors for ovarian cancer.
  
  
  METHODS
  A qualitative and quantitative study.
  
  
  METHODS
  Four UK hospitals.
  
  
  METHODS
  One hundred and twenty-four women referred to hospital with suspected ovarian malignancy.
  
  
  METHODS
  Women were interviewed prior to diagnosis (n = 63), or soon after. A thematic analysis was conducted. Emergent symptoms were quantitatively analysed to identify distinguishing features of ovarian cancer.
  
  
  RESULTS
  Symptoms in women with and without ovarian cancer.
  
  
  RESULTS
  Diagnoses comprised 44 malignancies, 59 benign gynaecological pathologies and 21 normal findings. Of the malignancies, 25 women had stage III or more disease, with an average age of 59 years. The benign/normal cohort was significantly younger (48 years). Multivariate analysis revealed persistent abdominal distension (OR 5.2, 95% CI 1.3-20.5), postmenopausal bleeding (OR 9.2, 95% CI 1.1-76.1), appetite loss (OR 3.2, 95% CI 1.1-9.2), early satiety (OR 5.0, 95% CI 1.6-15.7) and progressive symptoms (OR 3.6, 95% CI 1.3-9.8) as independent, statistically significant variables associated with ovarian cancer. Fluctuating distension was not associated with ovarian cancer (OR 0.4, 95% CI 0-4.1). Women frequently used the term bloating, but this represented two distinct events: persistent abdominal distension and fluctuating distension/discomfort.
  
  
  CONCLUSIONS
  Ovarian cancer is not a silent killer. Clinicians should distinguish between persistent and fluctuating distension. Recognition of the significance of symptoms described by women could lead to earlier and more appropriate referral.
authors.affiliation: Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UK. clare.bankhead@dphpc.ox.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Bankhead
authors.forename: C
authors.initials: C
authors.lastname: Collins
authors.forename: H
authors.initials: H
authors.lastname: Stokes-Lampard
authors.forename: P
authors.initials: P
authors.lastname: Rose
authors.forename: S
authors.initials: S
authors.lastname: Wilson
authors.forename: A
authors.initials: A
authors.lastname: Clements
authors.forename: D
authors.initials: D
authors.lastname: Mant
authors.forename: S T
authors.initials: ST
authors.lastname: Kehoe
authors.forename: J
authors.initials: J
authors.lastname: Austoker
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000209:etiology; D042241:Early Diagnosis; D005221:Fatigue / Q000209:etiology; D001068:Feeding and Eating Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008796:Metrorrhagia / Q000209:etiology; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis*; D014555:Urination Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology