Symptom Index of Ovarian Cancer

Cancer is among the leading causes of death worldwide, accounting for 8.8 million deaths in 2015.1 Ovarian cancer accounts for four percent of all cancer in women with more than 200000 new cases each year and 6.6 new cases per 100,000 women per year.2 It is seventh most common causes of death from cancer in Asia.3 The incidence of ovarian cancer in Nepal is also increasing with incidence of 0.8% in 2003 and 2.3% in 2013.4 World Health Organization (WHO) has estimated that the ovarian cancer is responsible for 7% of total deaths from cancer among women in Nepal.5


INTRODUCTION
Cancer is among the leading causes of death worldwide, accounting for 8.8 million deaths in 2015. 1 Ovarian cancer accounts for four percent of all cancer in women with more than 200000 new cases each year and 6.6 new cases per 100,000 women per year. 2 It is seventh most common causes of death from cancer in Asia. 3 The incidence of ovarian cancer in Nepal is also increasing with incidence of 0.8% in 2003 and 2.3% in 2013. 4 World Health Organization (WHO) has estimated that the ovarian cancer is responsible for 7% of total deaths from cancer among women in Nepal. 5 In early cancer (FIGO stage 1 and 2), the survival is 80-90% compared to 25% in late cancers (FIGO 3 and 4) and is associated with good prognosis. [6][7] Ovarian cancer was said to be the silent killer as symptoms did not develop until the disease reached advanced stages, when the chance of a cure was poor. 8 Studies of symptoms have have gastrointestinal, abdominal, and urinary symptoms. [9][10][11] out association of Symptom Index (SI) with ovarian cancer.

METHODS
It was a hospital based case control study conducted in department of Gynecology and Obstetrics, TUTH, Maharajganj, Kathmandu from 13th April 2013 to 12th April 2014.
All patient visiting Gynecology Outpatient Department (OPD) or admitted in the Female Surgical Ward (FSW) with histopathology Controls were taken as age matched women with benign ovarian tumor at the ratio of 1:2. The cases included women with ovarian cancer histologically, women admitted in the of ovarian tumor for neoadjuvant or adjuvant chemotherapy, patients of ovarian malignancy coming for follow up after surgery either to OPD or to FSW. Similarly, those cases admitted to female surgical ward with suspicion of malignancy and who underwent laparotomy for the same were also included, but taken into study for analysis only if histopathological women admitted to FSW for adnexal masses other than suspected or proven malignancy by examination or ultrasonography and histopathology as well cases suspected as malignancy who underwent surgery but Women in whom the primary diagnosis of malignancy was in doubt or with malignancy of other organs were excluded. Patients who could not recall their symptoms presenting excluded from the study.
All patients were explained about the study and consent was taken. Those who agreed to participate were taken in the study. The age, parity, education status and ethnicity of both cases and controls were taken into account. The histopathology diagnosis of all women was noted. Among cases the surgical stage of the tumor was noted from the operation note as well as from the discharge paper or referral documents whatever is available with the patient. Patients were asked in details regarding the symptoms associated with ovarian cancer. All information was taken and  Table 2).
Presence of various symptoms included in Symptom Index (SI) in both cases and controls is presented in Table 3. Around 96% of cases and 93% controls presented with abdominal However, abdominal bloating, increased compared to controls. Urinary symptoms, as urinary urgency and urinary frequency were neither found in cases nor in controls.

DISCUSSION
improves the survival of patients with ovarian cancer. Early recognition of symptoms by both medical providers and patients is crucial in order to improve the outcomes of the patients. In our study we focused on role of symptom recognition in the early diagnosis of ovarian cancer.
Increasing age is a major risk factor, and the highest incidence rates are for women aged 60-64 and above. 12 In our study 30 (50%) of cases were in the age group of 40-50 years. Mean age of cases was 45.67 years with the smallest age group being 20-30 years and largest age group being more than 60 years.
Our study showed that epithelial ovarian cancers were more than 50% of histopathology proven ovarian cancer.  23 However various studies have reported that advanced stage ovarian cancer had a higher number of symptoms. 24,25 This may be due to recall bias as patients were interviewed during various stages of treatment as later after or during treatment and follow up. The other reason could be small number of patients in late stage disease (17%) and duration of the study was short comparing with longer duration of study in other studies.

CONFLICT OF INTEREST:
None.