Differences in symptoms between patients with benign and malignant ovarian neoplasms Cara A. Attanucci, MD, Harrison G. Ball, MD, Susan L. Zweizig, MD, Annette H. Chen, MD* Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Massachusetts Medical Center, Worcester Received for publication September 11, 2003; revised December 31, 2003; accepted January 21, 2004 – Objective: The purpose of this study was to determine the symptoms that are experienced by pa- tients who receive a diagnosis of early ovarian cancer and to compare those symptoms with the symptoms that are experienced by patients with late ovarian cancer, borderline ovarian cancer, and benign ovarian neoplasms. Study design: This study used a retrospective case-control design. Cases of invasive and border- line ovarian cancer (n = 147 patients) were compared with 76 patients with benign ovarian neo- plasms. Results: Patients with early ovarian cancer were significantly more likely to have symptoms of mass effect (urinary frequency, constipation, palpable mass, pelvic pressure) compared with pa- tients with benign ovarian neoplasms (67% vs 15%; P!.001), late stage disease (67% vs 40%; P = .008), and borderline cancer (67% vs 33%; P = .007). Conclusion: Mass effect symptoms were the only symptoms that differentiated patients with early- stage ovarian cancer from all other groups of patients. However, one third of the patients with early ovarian cancer did not report any of these symptoms. Ó 2004 Elsevier Inc. All rights reserved. KEY WORDS Ovarian cancer symptom Early diagnosis – In 2003, an estimated 25,400 women will be diag- nosed with ovarian cancer in the United States and an estimated 14,300 women will die of the disease. 1 Under- standing symptoms of early ovarian cancer may help clinicians and patients to identify ovarian cancer at an earlier more curable stage. Several small retrospective chart reviews and one large national survey have examined the symptoms of ovarian cancer. 2-6 These studies suggest that nearly all patients who have ovarian cancer, regardless of stage, are symptomatic and that the predominant symptoms are gastrointestinal and constitutional. The major limitation of these retrospective studies is the reliance on postdiagnosis techniques to identify symptoms, which introduces recall bias. Furthermore, these studies compared women with ovarian cancer with population-based control subjects. The purpose of this study was to compare the symptoms that are experienced * Reprint requests: Annette H. Chen, MD, 119 Belmont St, Worcester, MA 01605. E-mail: chena@ummhc.org www.elsevier.com/locate/ajog American Journal of Obstetrics and Gynecology (2004) 190, 1435e7 0002-9378/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ajog.2004.01.077