Ovarian Cancer Early Diagnosis: Symptom-Triggered Testing

The effectiveness of symptom-triggered testing in identifying early-stage ovarian cancer is assessed in a recent study published in the International Journal of Gynecologic Cancer.

Enhancing the prognosis of Patients with Ovarian Cancer
Ovarian cancer ranks as the sixth most common cause of cancer-related fatalities in the United Kingdom. In comparison to women diagnosed with advanced stage cancer, the majority of women with early-stage ovarian cancer—defined by the International Federation of Gynecology and Obstetrics (FIGO) as stage I or II—have improved five-year survival rates.

Clinical trials carried out in the United States and the United Kingdom have shown that ovarian cancer screening does not appear to significantly influence mortality rates, but it can improve stage detection. A significant obstacle to the timely detection of this condition is the lack of specific symptoms and low incidence of this illness.

Physicians have discovered a trifecta of symptoms associated with this cancer: enlarged and bloated abdomen, early satiety, and discomfort. To raise awareness among clinicians, a symptom index was created based on these symptoms for national standards.

Many U.K. and U.S.-based cancer groups, including the American Cancer Society, Society of Gynecologic Oncology, and Foundation for Women’s Cancer, have backed symptom-triggered testing of this cancer. The National Institute for Health and Care Excellence (NICE) in the United States states that a woman should see a gynecologist within two weeks after noticing symptoms. Following that, women should have a transvaginal ultrasound scan and have their levels of the cancer antigen 125 (CA125) evaluated. These procedures together are known as a “fast-track referral pathway.”

While there was no overall mortality rate reduction observed in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), the screening approach has improved short-term outcomes by enabling the identification of women with high-grade serous ovarian cancer at stages I and II.

The proportion of women undergoing early therapies, such as surgery or adjuvant chemotherapy, may rise if this cancer is discovered early enough, potentially increasing survival rates.

About the Study
In order to evaluate risk prediction models in pre- and post-menopausal women with suspected ovarian cancer, Refining Cancer Test accuracy Scores (ROCkeTS) for this condition was an observational study that enrolled people. This descriptive study is still being conducted. Using the fast-track referral approach, high-grade serous ovarian cancer was identified in all of the women.

Women with high CA125 levels or abnormal imaging from several hospitals around the United Kingdom, ranging in age from 16 to 90, were assessed for the study. At the start of the trial, each participant filled out a questionnaire, and blood samples were taken in order to find biomarkers.

There were three categories for the disease’s extent: low, moderate, and high. The residual tumor load, or cytoreduction, was also measured.

In conclusion
According to the study’s findings, the fast-track method after symptom-triggered testing can identify approximately 25% of women with high-grade serous ovarian cancer, the most deadly subtype of the disease, at an early stage. Symptom-triggered testing may even increase the survival rates of patients with this cancer and effectively identify women with minimal disease burden. It may also help achieve high complete cytoreduction rates.

The observed stage distribution in this study indicates that there is a chance of selection bias. No statistically significant changes in performance status, illness stage, or cytoreduction rates were seen, likely because to the small number of women enrolled through the emergency pathway or other outpatient referrals.

For more information: Symptom-triggered testing detects early stage and low volume resectable advanced stage ovarian cancer, International Journal of Gynecologic Cancer, https://doi.org/10.1136/ijgc-2024-005371