Analysis of Early Symptoms of Women with Malignant Ovarian

Neoplasm in Adam Malik General Hospital

Muhammad Rizki Yaznil

, Hilma Putri Lubis

, M. Fauzie Sahil

, and Henry Salim Siregar

Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Subjective Symptoms, Ovarian Cancer.

Abstract: The aim of this study was to determine the early symptoms that are experienced by patients with ovarian

cancer and compared with non-ovarian neoplasm. This study used an analytical retrospective design. Study

participants included 54 women with ovarian cancer in Adam Malik General hospital between January until

August 2016. Cases of ovarian cancer (n=25 patients) were compared with 29 patients with non-ovarian

neoplasms. Information concerning symptoms was obtained via interview. From this study, we found that 11

significant subjective complaints in ovarian cancer patients (p<0.05) compared with the controls i.e. tired /

less powerful, abdominal pain, flatulence / quick feel full, bigger stomach, palpable lump in the stomach,

heartburn, pelvis feels heavy / full, hard breathing, low back pain, lower back pain, weight gain.The early

symptoms of women with ovarian cancer were statistically significant are: tired / less powerful, abdominal

pain, flatulence / rapid feeling, full of stomach, palpable lumps in stomach, heartburn, pelvis feel heavy / full,

hard breathing, low back pain, weight gain.

1 INTRODUCTION

Ovarian cancer is still a cause of high mortality due

to cancer. In 2005-2009 as many as 8.2 per 100.000

women died from cancer. It is estimated that around

22.280 women in 2012 will suffer from ovarian

cancer and about 15,500 of them die from ovarian

cancer. Based on age, the incidence of ovarian cancer

is 12.7 per 100,000 women annually (Howlader,

2012). In Indonesia from 2007-2011 1623 new cases

of ovarian cancer from 7199 cases of gynaecologic

cancer occurred (Inasgo, 2012). Ovarian cancer is the

second most common gynaecological cancer after

cervical cancer in Indonesia (Inasgo, 2012), (Smith,

2006), (Ranney, 1979), (Kennedy, 1981), (Igoe,

1985), (Flam, 1988), (Wikborn, 1993), (Nelson,

1999), (Eltabbakh, 1999), (Goff, 2000), (Kirwan,

2002), (Copeland, 2007). Some studies suggest that

ovarian cancer has early symptoms similar to those of

other diseases, so patients are treated with no specific

complaints (Inasgo, 2012), (Jemal, 2007), (Smith,

2006), (Ranney, 1979), (Kennedy, 1981), (Igoe,

1985), (Flam, 1988), (Wikborn, 1993), (Nelson,

1999), (Eltabbakh, 1999), (Goff, 2000), (Kirwan,

2002), (Copeland, 2007), (Berek, 2007), (FIGO,

2000).

In developing countries, especially in

Indonesia, public knowledge and awareness about

ovarian cancer is lacking, and a very strong

community culture of disease should be "sick".

Therefore, symptoms are the main reason people to

seek a doctor. For this reason, researchers want to

know whether ovarian cancer and benign ovarian

tumours have early symptoms, and whether there are

differences in symptoms between the two, to help

doctors and primary healthcare workers raise

awareness and care in ovarian cancer screening when

they have symptoms -the initial symptom. The aim of

this study was to determine the symptoms that are

experienced by patients with ovarian cancer and to

compare those symptoms with the symptoms that are

experienced by patients with non-ovarian neoplasm.

2 MATERIAL AND METHODS

This study used an analytical retrospective design.

Study participants included 54 women with ovarian

cancer from January until August 2016 in Department

of Obstetrics and Gynecology, Faculty of Medicine,

Universitas Sumatera Utara, Haji Adam Malik

General hospital, Medan, Indonesia. We divided the

samples into two groups: cases of ovarian cancer

Yaznil, M., Lubis, H., Sahil, M. and Siregar, H.

Analysis of Early Symptoms of Women with Malignant Ovarian Neoplasm in Adam Malik General Hospital.

DOI: 10.5220/0010081506390643

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

639-643

ISBN: 978-989-758-449-7

639

(n=25 patients) as study group were compared with

29 patients with non-ovarian neoplasms as control

group. Information concerning symptoms and

presentation history was obtained via interview.

Characteristics of patients in general, histopathologic,

staging, operative procedure during laparotomy are

recorded. The inclusion criteria of this study was

Patients with histopathologic ovarian cancer

diagnosis, patients with full awareness / can answer

questions well and Willing to follow the research.

Exclusion criteria: patients with tumor of intestinal,

stomach, liver, uterine, cervix, vagina, vulva, breast

with different histopathology with ovarian cancer

(double primer), and with hepatitis, heart disease,

pulmonal disease in medical record. All previous

samples were asked for approval to be included in this

study and then interviewed with a questionnaire

provided by the researcher. Characteristics of patients

in general, histopathologic diagnosis, stage at

diagnosis, actions performed during laparotomy are

recorded. After interviews, the data were collected,

tabulated and analyzed. Data is presented in the form

of data analysis using SPSS.

3 RESULTS

This study was conducted during July 2011, and

found 59 subjects with 25 cases of ovarian cancer

were included in the case group, 29 respondents as

control and 5 cases excluded because of

histopathology of benign ovarian tumor.

Characteristics of the subjects based on age and

education can be seen in table 1. Table 1 showed that

majority of the subjects were in the range 20-29 years

age for ovarian cancer cases as many as 7 subjects

(28%), and in the range 40-49 years age for control as

many as 9 subjects (31%) and The level of education

at the high school level in the case group was 9

subjects (36%) and the elementary school level in the

control group was 14 subjects (48.4%).

Characteristics of the subjects based on clinical

diagnose and histopathology can be seen in table 1.

Table 1 showed that in the control group, the most

clinical diagnosis was uterine myoma as many as 10

subjects (34.5%). In the case group, the most

histopathological type was epithelial ovarian cancer

as many as 18 subjects (72%) and germ cells as many

as 7 subjects (28%). From table 3, we found eleven

early symptoms of women with malignant ovarian

neoplasm compared with control (p<0.05), some of

the early symptoms were tired/less powerful,

stomachache, flatulence, the stomach gets bigger,

palpable lump in the abdomen, heartburn, the pelvis

feel heavy/full, hard to breath, low back pain, lower

back pain, weight gain. After calculating odds ratios,

complaints that had the greatest OR were greater

stomach complaints (OR 44.09), then heartburn (OR

10.89), lower back pain (OR 5.78), abdominal pain

(OR 4.88), low back pain (OR 4.88), felt a lump in

the abdomen (OR 4.04), the pelvis felt heavy / full

(OR 3.77), flatulence / fast feeling full (OR 3.48),

tired / lacking power (OR 3.16).

Table 1: The Characteristics of Subjects Based on Age and

Education.

Educa

tion

Elementary 5 20 14 48.4 19

Junior high 7 28 9 31 16

High

school

9 36 6 20.6 15

University 4 16 0 0 4

TOTAL 25 10

29 100 54

Characteristics Case Control

Total

n % n %

Age

10-19 y.o 1 4 0 0 1

20-29 y.o 7 28 2 6.8 19

30-39 y.o 4 16 6 20.6 10

40-49 y.o 4 16 9 31 13

50-59 y.o 5 20 8 27.6 13

60-69 y.o 4 16 2 6.8 6

≥70 y.o 0 0 2 6.8 2

TOTAL 25 100 29 100 54

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

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Table 2: The Characteristics Based On Clinical Diagnosis and Histopathology.

Characteristics Case Control

Total

n % n %

Clinical

Diagnose

Ovarian cancer 25 100 0 0 25

Susp Ca Cervix 0 0 4 13.8 4

Susp Ca Vulva 0 0 3 10.3 3

Vulvo-vaginitis 0 0 7 24.1 7

Myoma Uterine 0 0 10 34.5 10

Hydatidiform mole 0 0 1 3.4 1

Uterine prolapse 0 0 4 13.8 4

TOTAL 25 100 29 100 54

Histo-pathology Epithelial Ovarian Cancer 18 72 NA NA NA

Malignant Germ Cell Tumor 7 28 NA NA NA

TOTAL 25 10

NA NA NA

Table 3: Comparison of subjective complaints between ovarian cancer patients and controls.

No. Subjective complaints p OR

1 Tired / less powerful 0.04* 3.16

2 Pain / discomfort in the

elvis

0.81* 1.14

3 Uncomfortable in the

stomach

0.36* 1.66

4 Stomach ache 0.00* 4.88

5 Flatulence / quickly feel

full

0.02* 3.48

6 The stomach

ets bi

0.00* 44.09

7 Palpable lump in the

abdomen

0.01* 4.04

8 Heartburn 0.01** 10.89

o appetite 0.85* 1.11

10 Difficult / disturbed

defecation

0.12* 2.70

11 Often flatus 0.34** 2.57

12 The pelvis feels heavy /

full

0.03* 3.77

13 Hard to breathe 0.00* NA

14 Difficult urination 1.00** 0.91

15 Frequent urination 0.77* 1.21

16 Painful urination 0.36** 0.26

17 Swollen fee

0.93**

Analysis of Early Symptoms of Women with Malignant Ovarian Neoplasm in Adam Malik General Hospital

641

18 Low back pain 0.00* 4.88

19 Lower back pain 0.01* 5.78

20 Wei

ht loss 0.06* 2.90

21 Wei

ain 0.01** NA

22 Discharge from the

enitals

0.49* 1.48

23 Pain durin

intercourse 0.43** 0.42

*Chi square

**Fisher’s exact test

4 DISCUSSION

(Goff, 1998) surveyed 1725 women in Canada,

they got 5% of patients reported no symptoms before

ovarian cancer diagnosis, 61% reported abdominal /

abdominal enhancement, 57% reported flatulence,

47% tired, 36% stomach pain, 31% indigestion, 27%

frequent urination, 26% pelvic pain, 25%

constipation, 24% urinary incontinence, 23% lower

back pain, 17% pain during intercourse, 16% no

appetite, 14% palpable lumps in the abdomen, 13%

abnormal vaginal bleeding, 11% weight loss, 9%

nausea, 3% post-sex bleeding, 1% of leg swelling and

1% diarrhea (Goff, 2000).

(Kennedy, 1981) in their study also found that

early symptoms of important ovarian cancer were

stomach enlargement, abnormal vaginal bleeding and

gastrointestinal symptoms (Kennedy, 2001).

Webb PM et a.l in their study from 811 women in

Australia with early-stage, advanced and borderline

ovarian cancer gained only 7% of women with early-

stage ovarian cancer and 4% of women with

advanced, non-symptomatic late-stage ovarian cancer

from those with the most symptoms, symptoms are

abdominal pain (44%) or abdominal enlargement

(39%), symptoms of abdominal lumps (12%) and

other gynaecological symptoms (12%) are less

common. In women with early-stage ovarian cancer

it is more common to report abdominal enlargement

symptoms and urinary symptoms and rarely report

symptoms of gastrointestinal and or fatigue (malaise)

(Webb, 2004).

(Igoe BA, 1997) in his study on the symptoms

felt in patients with ovarian cancer in 50 women get

the most symptoms are symptoms of gastrointestinal,

and then symptoms of menstrual cycle changes (Igoe,

1997).

(Smith L, 2006) in their study in the US with

data from 1994-1999 on early symptoms of ovarian

cancer found no symptom difference quickly fatigue

and symptoms of urinary disorders between patients

with ovarian cancer with control. The most common

symptoms of ovarian cancer include abdominal pain

(30.6%, OR 6.0), abdominal enlargement (16.5%, OR

30.9), pelvic pain (5.4%, OR 2.3). In a study by Smith

LH this control was breast cancer patients (Smith,

2005).

In a study by (Eltabbakh GH, 1999) from 72

women with ovarian tumour borderline and 50

women with ovarian cancer resulted in 80% of

patients having symptoms such as abdominal pain

and pelvic (34.7%), flatulence (31.9%) and vaginal

bleeding (19.4%) (Eltabbakh,, 1999).

5 CONCLUSION

The early symptoms of ovarian cancer patients at

Adam Malik General Hospital Medan were

statistically significant: tired / less powerful,

abdominal pain, flatulence / rapid feeling, full of

stomach, palpable lumps in stomach, heartburn,

pelvis feel heavy / full, hard breathing, low back pain,

weight gain. So that every woman who comes with

no specific complaints such as fatigue / less powerful,

abdominal pain, flatulence / quickly feel full, bigger

stomach, palpable lumps in the stomach, heartburn,

pelvis feels heavy / full, hard breathing, low back

pain, lower back pain, weight gain, complete physical

examination should be performed and should

consider the diagnosis of ovarian cancer as one of the

differential diagnoses.

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