Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer - An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Sep 24, 2026

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Objective: UKCTOCS enables symptom exploration in preclinical invasive epithelial ovarian cancer (iEOC). The analysis compares screen-detected (pre-clinical, PC) cancers with clinically diagnosed (CD) cancers. Methods: Among 202,638 postmenopausal women, symptom details were extracted from clinical-assessment forms and records, with descriptive statistics used across early (I/II) and advanced (III/IV) high-grade serous cancer. Results: PC cancers showed earlier diagnosis and distinct symptom profiles, including more gastrointestinal and systemic symptoms. Conclusions: Findings support refining key alert symptoms for early tubo-ovarian cancer.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Highlights

Key associations between preclinical symptoms and outcomes

Abstract

Objective

Methods

Results

Conclusions

Introduction

Gynecologic Oncology 179 (2023) 123–130 Contents lists available at ScienceDirect Gynecologic Oncology journal [homepage:](homepage: www. else vier. com/locate/ygy no)[ www. else vier. com/locate/ygy no](homepage: www. else vier. com/locate/ygy no) Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer – An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) James Dilley a, Aleksandra Gentry-Maharaj b,c, Andy Ryan b, Matthew Burnell b, Ranjit Manchanda a,d, Jatinderpal Kalsi c, 1, Naveena Singh e, Robert Woolas f, Aarti Sharma g, Karin Williamson h, Tim Mould i, Lesley Fallowﬁeldj, Stuart Campbell k, Steven J. Skates l, Alistair McGuire m, Mahesh Parmar b, Ian Jacobs c, Usha Menon b,⁎ a Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK b MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK c Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK d Wolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK e Department of Cellular Pathology, Barts Health NHS Trust, London, UK f Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK g Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK h Department of Gynaecological Oncology, Nottingham University Hospitals, Nottingham, UKi Department of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK j Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Sussex, UK k Create Health London, London, UK l Massachusetts General Hospital and Harvard Medical School, Harvard, MA, USAm London School of Economics, London, UK H I G H L I G H T S • High alert ovarian cancer symptoms based on reports by clinically diagnosed women are associated with poorer outcomes. • In UKCTOCS, we explore prospectively preclinical symptoms in women detected by screening earlier in the natural history. • In high grade serous ovarian cancer, the symptom proﬁle was different between women with preclinical and clinical disease. • Women with preclinical early stage high grade serous ovarian cancer reported more gastrointestinal and systemic symptoms. • Key symptoms were change in bowel habits, dyspepsia and tiredness. G R A P H I C A L A B S T R A C T ⁎ Corresponding author at: MRC Clinical Trials Unit at UCL, 2nd Floor, Institute of Clinical Trials & Methodology, University College London, London WC1V 6LJ, UK. [E-mail address:](E-mail address: u.menon@ucl.ac.uk)[ u.menon@ucl.ac.uk](E-mail address: u.menon@ucl.ac.uk) (U. Menon). 1 Present address: AGE Research Unit, School of Public Health. Imperial College London, London, UK. [https://doi.org/10.1016/j.ygyno.2023.11.005](https://doi.org/10.1016/j.ygyno.2023.11.005) 0090-8258/© 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). a r t i c l e i n f o Article history: Received 1 August 2023 Received in revised form 2 November 2023 Accepted 6 November 2023 Available online 18 November 2023 Keywords: Ovarian cancer Symptoms UKCTOCSGOFF index NICE a b s t r a c t 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) 2:1:1 to no screening or annual screening till Dec 31,2011, using a multimodal or ultrasound strategy. Follow-up was through nati

FAQs

What is the purpose of this exploratory analysis within UKCTOCS?

To compare symptoms in preclinical (screen-detected) invasive epithelial ovarian cancer with symptoms in clinically diagnosed cases and to understand how symptom profiles differ.

How were women allocated and followed in the UKCTOCS setting described here?

Postmenopausal women were randomly allocated to no screening or to screening strategies (multimodal or ultrasound), with follow-up through national registries and outcome adjudication for ovarian cancer diagnosis and staging.

What key symptom differences were observed between preclinical and clinical disease?

In symptomatic early-stage high-grade serous cases, preclinical women reported more gastrointestinal symptoms (change in bowel habits and dyspepsia) and more systemic symptoms such as lethargy/tiredness compared with clinically diagnosed women.

Sep 24, 2026

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