The results of a new U.K. study showed that testing prompted by symptoms can pick up aggressive, early-stage ovarian cancer in 1 in 4 affected patients. Furthermore, surgery was successful in removing almost all visible cancer in approximately 75% of the women who had been diagnosed through symptom-triggered testing.
The findings of the study, published in the International Journal of Gynaecological Cancer and funded by the U.K.'s National Institute for Health and Care Research, showed that the standard protocol for detecting high-grade serous ovarian cancer -- the most common, aggressive, and lethal form of ovarian cancer -- is effective for diagnosis of the disease, even at early stages.
Ovarian cancer ranks as the seventh most common cancer in women worldwide and the sixth most common in the U.K. While the majority (93%) of patients diagnosed with early-stage (stages I or II) ovarian cancer survive for more than five years, the five-year survival rate for patients diagnosed with the advanced stages (III or IV) is 13%.
In 2011, the U.K. adopted symptom-triggered testing for ovarian cancer in which patients were tested for levels of the protein CA125 and given an ultrasound scan based on reporting symptoms such as pain, abdominal bloating or swelling, and early satiety (i.e., feeling full quickly when eating). The protocol included a fast-track referral for abnormal results for hospital review by a gynecologist within two weeks.
The team, led by researchers at the University of Birmingham, determined that complete surgical removal of the cancer was possible in even advanced disease as long as investigation and treatment were expedited for patients with symptoms deemed suspicious under the protocol.
The researchers analyzed data from 1,741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study being performed at 24 U.K. hospitals. All of the women had been fast-tracked for treatment under the symptom-triggered testing protocol.
Among participants in the study, 119 (7%) were diagnosed with high-grade serous ovarian cancer with an average age of 63; 90% had gone through menopause. Approximately 1 in 4 (30; 25%) had stage I or II disease. The extent of cancer was low in 43 of the patients (36%), moderate in 34 (29%), and high in 32 (27%); information on disease extent wasn't available for 10 (8.5%) patients.
Surgery to remove as much of the tumor as possible, which is associated with longer survival, was carried out in 93 of the patients (78%), with 78 (65%) undergoing surgery ahead of chemotherapy and 36 (30%) being given chemotherapy to shrink the tumor ahead of surgery. Only five (4%) patients were recorded as not undergoing surgery, while information on surgery was not available for 17 (14%) patients.
Visible cancerous tissue was completely removed in 73 of the patients (61%), and almost completely removed in 18 (15%). The disease was determined to be inoperable in nine patients (8%).
"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," Sudha Sundar, professor of gynaecological cancer at the University of Birmingham and the Pan Birmingham Gynaecological Cancer Centre at Sandwell and West Birmingham Hospital NHS trust, an author of the study, said.
"More importantly, our findings emphasize 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."
