Referring women with potential ovarian cancer symptoms for testing can identify aggressive forms of the disease early, according to international researchers evaluating a change in UK protocols adopted in 2011. Ovarian cancer can be hard to diagnose because the symptoms are vague, and it was believed that by the time symptoms appear, the cancer is usually in an advanced stage. The researchers looked at the cases of 1,741 women in the UK who had undergone ‘symptom-triggered testing’, the new protocol where women with pain, bloating/swelling, and feeling full soon after starting to eat, especially those over 50, were tested for signs of ovarian cancer in the blood. The researchers say 7% of the women were diagnosed with high-grade, serious ovarian cancer, and one in four of that group had early stage I or II disease. Complete tumour removal was possible for 60% of the women with serious ovarian cancer. The researchers say this study shows symptom-triggered testing has the potential to improve outcomes for women with a cancer that has so far been hard to tackle.
Journal/conference: International Journal of Gynecological Cancer
Link to research (DOI): 10.1136/ijgc-2024-005371
Organisation/s: Pan-Birmingham Gynaecological Cancer Centre, UK
Funder: This study is funded by a grant from National Institute of Heath Research,
Health Technology assessment HTA 13/13/01. ROCkeTS GEN is funded by Cancer
Research UK, through Stand up to Cancer fundraising campaign.
Media release
From: BMJ Group
‘Symptom triggered’ testing can pick up early stage aggressive ovarian cancer in 1 in 4 of those affectedComplete tumour removal also possible in 60% of those diagnosed with this systemFindings challenge assumption that symptoms always signal advanced ovarian cancer‘Symptom triggered testing’, prompted by symptoms such as pain, abdominal bloating/swelling, and feeling full soon after starting to eat, can pick up early stage aggressive ovarian cancer in 1 in 4 of those affected, finds a data analysis, published online in the International Journal of Gynecological Cancer.And complete surgical removal of the cancerous tissue was possible in 60% of those diagnosed in this way.The findings challenge the assumption that symptoms always signal advanced disease in women with ovarian cancer, conclude the researchers.Ovarian cancer is the sixth most common cause of cancer death in the UK. But while most (93%) women diagnosed with early stage disease (I or II) survive for more than 5 years, only 13% of those diagnosed with advanced disease (stages III or IV) do so.Mounting evidence suggests that symptoms precede diagnosis by between 3 months and 3 years, but symptoms are often vague, making early detection difficult, explain the researchers.But symptoms such as pain, abdominal swelling and/or bloating, and feeling full soon after starting to eat are associated with ovarian cancer, and warrant urgent investigation, or ‘symptom triggered testing.’The UK adopted symptom-triggered testing for ovarian cancer in 2011. Women, especially those over the age of 50 with these symptoms, are tested for levels of the tell-tale protein CA125 in their blood and given an ultrasound scan. Abnormal results prompt a fast track referral to a gynaecologist within 2 weeks.But how effective this protocol is for picking up early stage disease in women with high grade serous ovarian cancer—the most common, aggressive, and lethal form of the disease—isn’t clear, say the researchers.To find out, they analysed data for 1741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study, which involves 24 UK hospitals. The women had all been fast tracked for treatment under the symptom-triggered testing protocol.In all, 119 (7%) of these women were diagnosed with high grade serous ovarian cancer. Their average age was 63, but ranged from 32 to 89; 90% had gone through the menopause.In most of these women (112; 94%) cancer didn’t hugely interfere with their daily lives, as they were classified with a performance status of 0 or 1, meaning they were either fully active, or were able to do everything but strenuous activities.One in four (30; 25%) had early stage I or II disease. Visible cancerous tissue was completely removed in 73 (61%) and almost completely removed in 18 (15%).The disease was only deemed to be inoperable in 9 (8%).The extent of cancer was low in 43 of the 119 (36%), meaning that it was localised in the pelvis; moderate in 34 (29%), meaning that it had spread to the lower abdomen; and high in 32 (27%), meaning that it had spread up to any of the liver, pancreas, diaphragm or spleen. Information on disease extent wasn’t available for 10 (8.5%) women.Surgery to remove as much of the tumour as possible, which is associated with longer survival, was carried out in more than 3 in 4 (93; 78%) women, with almost two thirds (78; 65%) having surgery ahead of chemotherapy.Thirty six (30%) women were given chemotherapy to shrink the tumour ahead of surgery; 5 (4%) didn’t have surgery; and information on this wasn’t available for 17 (14%).“Our figures demonstrate that in a real-world setting, symptom-based testing can potentially lead to diagnosis of high grade serous ovarian cancer with low disease spread and results in a high proportion of complete [surgical removal of the cancer],” write the researchers.The findings also show that complete surgical removal of the cancerous tissue is possible even in more advanced disease, providing that women with suspicious symptoms are expedited for investigation and treatment, they add.“These findings challenge the assumption that the disease should always be considered to be in its advanced stages in women once they develop symptoms,” they highlight.“More importantly, our findings emphasise the importance of increasing an awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway to improve patient outcomes.”