• Open Access

Identifying symptoms of ovarian cancer: a qualitative and quantitative study

Authors

  • CR Bankhead,

    Corresponding author
    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • a C Collins,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • b H Stokes-Lampard,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • b P Rose,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • d S Wilson,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • c A Clements,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • a D Mant,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • d ST Kehoe,

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author
  • and e J Austoker a

    1. a Cancer Research UK Primary Care Education Research Group, University of Oxford, Headington, Oxford, UKb Department of Obstetrics and Gynaecology and c Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, UKd Department of Primary Care, University of Oxford, Oxford, UKe Nuffield Academic Department of Obstetrics & Gynaecology, University of Oxford, The Women’s Centre, John Radcliffe Hospital, Headington, Oxford, UK
    Search for more papers by this author

  • Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

CR Bankhead, Department of Primary Care, University of Oxford, Headington, Oxford OX3 7LF, UK. Email clare.bankhead@dphpc.ox.ac.uk

Abstract

Introduction  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.

Design  A qualitative and quantitative study.

Setting  Four UK hospitals.

Sample  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.

Main outcomes  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.

Ancillary