Could your bloated belly be a sign of Ovarian Cancer?

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What will you do about a persistent bloated tummy? Should you be concerned? Ovarian cancer is among the first 5 cancers causing deaths in women in sub-Saharan Africa1. Evidence from a population based cancer registry in Ghana recorded more female cancers (69.6%) than male; with ovarian cancer being the 3rd commonest (11.3%)4. Similar results were observed in a large scale study in Nigeria11 where Ovarian cancer was reported as the second commonest (30.5%) with a higher proportion compared to other gynaecological cancers. The age of incidence was also relatively lower compared to other gynaecological cancers like cervical and endometrial10. It is estimated that more than 70% of women with ovarian cancer receive a diagnosis at a later stage of the disease2 resulting in poorer prognosis and thus, increased mortalities. One of the primary reasons for this delay is due to the painless growth of ovarian tumours3 which has earned it the infamous “silent killer” tag. This notwithstanding, it is believed that certain abdominal and urinary symptoms should be given a closer look to help in the early detection of ovarian cancers.

In a large case-control study to determine the symptoms associated with ovarian cancer, abdominal and gastrointestinal symptoms such as bloated tummy, abdominal pains and constipation were the most cited symptoms. It was observed that participants who reported persistence of these symptoms developed ovarian tumours compared to those who observed these symptoms 1-2times per month2. These findings have been confirmed by several studies with other symptoms such as feeling full quickly and nausea adding to the list6,7. Because these symptoms are not gynaecological in nature, more often than not, they are ignored or missed. This necessitated signing of a consensus statement to encourage primary care physicians to recognize these symptoms which suddenly arise with increasing severity as possible ovarian cancer signs.

What should you do? Due to changing dietary habits and the adoption of western lifestyles, many African women have central or abdominal obesity. Unfortunately, this is sometimes viewed as signs of good living and very few take active steps to report increase in abdominal girth or bloating. It is worthy to note that the symptoms discussed above could be indicative of other conditions such as bladder infections and irritable bowel syndrome and that; other factors such as genetics, parity (pregnancy and birth), urinary symptoms and age at menopause affect ovarian carcinogenesis8,9. Nevertheless, one should keep in mind that the rate of survival decreases from 80-90% to 20-30% when the disease is diagnosed late. The encouragement is to see your primary physician when you experience sudden increase in abdominal bloating and crampy abdominal pain with increasing severity. A longer interval between onset of symptoms and reporting results largely in poor prognosis. Remember, early diagnosis saves the day!

References:

  1. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
  2. Goff, B.A., Mandel, L.S., Drescher, C.W., Urban, N., Gough, S., Schurman, K.M., Patras, J., Mahony, B.S. and Andersen, M.R., 2007. Development of an ovarian cancer symptom index. Cancer, 109(2), pp.221-227.
  3. Smith, L.H., Morris, C.R., Yasmeen, S., Parikh‐Patel, A., Cress, R.D. and Romano, P.S., 2005. Ovarian cancer: can we make the clinical diagnosis earlier?. Cancer, 104(7), pp.1398-1407.
  4. Laryea, D.O., Awuah, B., Amoako, Y.A., Osei-Bonsu, E., Dogbe, J., Larsen-Reindorf, R., Ansong, D., Yeboah-Awudzi, K., Oppong, J.K., Konney, T.O. and Boadu, K.O., 2014. Cancer incidence in Ghana, 2012: evidence from a population-based cancer registry. BMC cancer, 14(1), p.362.
  5. Goff, B.A., Mandel, L.S., Melancon, C.H. and Muntz, H.G., 2004. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. Jama, 291(22), pp.2705-2712.
  6. Bankhead, C.R., Kehoe, S.T. and Austoker, J., 2005. Symptoms associated with diagnosis of ovarian cancer: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 112(7), pp.857-865.
  7. Rossing, M.A., Wicklund, K.G., Cushing-Haugen, K.L. and Weiss, N.S., 2010. Predictive value of symptoms for early detection of ovarian cancer. Journal of the National Cancer Institute, 102(4), pp.222-229.
  8. https://academic.oup.com/jnci/article/99/18/1359/925194
  9. Parazzini, F., Franceschi, S., La Vecchia, C. and Fasoli, M., 1991. The epidemiology of ovarian cancer. Gynecologic oncology, 43(1), pp.9-23.
  10. Nkyekyer, K., 2000. Pattern of gynaecological cancers in Ghana. East African medical journal, 77(10).
  11. Yakasai, I.A., Ugwa, E.A. and Otubu, J., 2013. Gynecological malignancies in Aminu Kano teaching hospital Kano: A 3 year review. Nigerian journal of clinical practice, 16(1), pp.63-66.