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Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer - An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
Dilley, James; Gentry-Maharaj, Aleksandra; Ryan, Andy; Burnell, Matthew; Manchanda, Ranjit; Kalsi, Jatinderpal; Singh, Naveena; Woolas, Robert; Sharma, Aarti; Williamson, Karin; Mould, Tim; Fallowfield, Lesley; Campbell, Stuart; Skates, Steven J; McGuire, Alistair; Parmar, Mahesh; Jacobs, Ian; Menon, Usha.
Affiliation
  • Dilley J; Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK.
  • Gentry-Maharaj A; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK; Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
  • Ryan A; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
  • Burnell M; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
  • Manchanda R; Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK.
  • Kalsi J; Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
  • Singh N; Department of Cellular Pathology, Barts Health NHS Trust, London, UK.
  • Woolas R; Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK.
  • Sharma A; Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK.
  • Williamson K; Department of Gynaecological Oncology, Nottingham University Hospitals, Nottingham, UK.
  • Mould T; Department of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK.
  • Fallowfield L; Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Sussex, UK.
  • Campbell S; Create Health London, London, UK.
  • Skates SJ; Massachusetts General Hospital and Harvard Medical School, Harvard, MA, USA.
  • McGuire A; London School of Economics, London, UK.
  • Parmar M; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
  • Jacobs I; Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
  • Menon U; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK. Electronic address: u.menon@ucl.ac.uk.
Gynecol Oncol ; 179: 123-130, 2023 Dec.
Article in En | MEDLINE | ID: mdl-37980767
ABSTRACT

OBJECTIVE:

UKCTOCS provides an opportunity to explore symptoms in preclinical invasive epithelial ovarian cancer (iEOC). We report on symptoms in women with pre-clinical (screen-detected) cancers (PC) compared to clinically diagnosed (CD) cancers.

METHODS:

In UKCTOCS, 202638 postmenopausal women, aged 50-74 were randomly allocated (April 17, 2001-September 29, 2005) 211 to no screening or annual screening till Dec 31,2011, using a multimodal or ultrasound strategy. Follow-up was through national registries. An outcomes committee adjudicated on OC diagnosis, histotype, stage. Eligible women were those diagnosed with iEOC at primary censorship (Dec 31, 2014). Symptom details were extracted from trial clinical-assessment forms and medical records. Descriptive statistics were used to compare symptoms in PC versus CD women with early (I/II) and advanced (III/IV/unable to stage) stage high-grade-serous (HGSC) cancer. ISRCTN-22488978; ClinicalTrials.gov-NCT00058032.

RESULTS:

1133 (286PC; 847CD) women developed iEOC. Median age (years) at diagnosis was earlier in PC compared to CD (66.8PC, 68.7CD, p = 0.0001) group. In the PC group, 48% (112/234; 90%, 660/730CD) reported symptoms when questioned. Half PC (50%, 13/26PC; 36%, 29/80CD; p = 0.213) women with symptomatic HGSC had >1symptom, with abdominal symptoms most common, both in early (62%, 16/26, PC; 53% 42/80, CD; p = 0.421) and advanced (57%, 49/86, PC; 74%, 431/580, CD; p = 0.001) stages. In symptomatic early-stage HGSC, compared to CD, PC women reported more gastrointestinal (change in bowel habits and dyspepsia) (35%, 9/26PC; 9%, 7/80CD; p = 0.001) and systemic (mostly lethargy/tiredness) (27%, 7/26PC; 9%, 7/80CD; p = 0.017) symptoms.

CONCLUSIONS:

Our findings, add to the growing evidence, that we should reconsider what constitutes alert symptoms for early tubo-ovarian cancer. We need a more nuanced complex of key symptoms which is then evaluated and refined in a prospective trial.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ovarian Neoplasms / Early Detection of Cancer Limits: Female / Humans Country/Region as subject: Europa Language: En Journal: Gynecol Oncol Year: 2023 Document type: Article Affiliation country: United kingdom
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Ovarian Neoplasms / Early Detection of Cancer Limits: Female / Humans Country/Region as subject: Europa Language: En Journal: Gynecol Oncol Year: 2023 Document type: Article Affiliation country: United kingdom