Ovarian Cancer Symptoms

This article describes the symptoms that may suggest the presence of ovarian cancer.  The major problem with this task is that ovarian cancer is notorious for NOT having symptoms.  Many cases of ovarian cancer are advanced and present for some time before detected.  Early detection of ovarian cancer and screening for it is a real problem.  Ovarian cancer is the 8th most common cancer diagnosed in women and the 5th most common cause of death from cancer in women, in the United States.  Ovarian cancer is the second most common cancer diagnosed in the female genital tract, behind cervical cancer.  Ovarian cancer is the most common cause of death from a gynecologic tumor.

There currently is not a widespread effective way to screen for the presence of ovarian cancer.  With early detection, in theory, almost every cancer should be treatable and possibly curable.  This is the reason we screen for common cancers such as colonoscopy for colon cancer and mammography for breast cancer.  Ovarian cancer lacks a true screening test that can be used in the same way.

We will describe some symptoms that are associated with ovarian cancer, but it should be emphasized that these symptoms are quite non-specific and may not be very helpful in detecting ovarian cancer.  Risk factors for ovarian cancer have been explored.  Identifying who is at risk may give the best chance at early detection.  Certain families have abnormal cancer genes such as the BRCA mutation.  This mutation leads to the early development of breast and/or ovarian cancer.  If a woman has relatives that have had breast or ovarian cancer develops at a young age, it may be worthwhile discussing getting tested for the BRCA mutation.  Once diagnosed with this mutation, preventative measures can be undertaken such as prophylactic removal of the ovaries or very frequent breast screening. Some common factors that are thought to be risks for ovarian cancer are:

  • Older age
  • Fatty diet
  • Relatives with ovarian cancer
  • Difficulty with pregnancy / infertility
  • Lack of children (i.e. nulliparity)
  • Abnormal ovulation history

The ovaries can have a number of diseases and disorders in addition to cancer.  Large cysts or tumors can grow on the ovary that is not cancer.  The difference between a non-cancer and cancer tumor is that a cancer has abnormal cells that try to invade into other areas of the body.  A growth that is not cancer will swell and cause pressure on adjacent structures but will not invade beyond its normal boundaries despite being much larger than it should be.

The real challenge with ovarian cancer stems from the lack of symptoms and difficulty in early detection.  This is analogous to a tumor in the tail of the pancreas that grows and spreads before there is a chance to detect it.  Some cancers display early signs and are easier to spot.  For example, a woman may feel a breast tumor and be prompted to see a doctor for a possible breast cancer.  A young man may feel a lump on his thyroid gland and be prompted to get evaluated for a possible thyroid cancer.  There is no practical way to “feel” your ovary.  A tumor of the ovary often has no symptoms.  This allows growth and spread of the cancer cells without treatment.  Ovarian cancer is more common in older women, and when diagnosed in a woman older than 65 years old it is almost always far advanced in stage.  The most common age for diagnosis with ovarian cancer is around 60 but can be diagnosed rarely in the 30’s or much later in life in the 80’s.

Symptoms associated with ovarian cancer are largely due to the effect of a mass in the pelvis and pressure of nearby structures.  This includes symptoms such as:

  • Abdominal distention
  • A sensation of bloating
  • Frequent urination
  • Difficulty moving the bowels
  • Frequent bowel movements
  • Weight Loss OR Gain
  • A sense of “fluid wave” across the abdomen
  • Difficulty eating or full feeling
  • Back Pain
  • Lack of energy

The problem with this list of symptoms is that we all might feel tired or constipated from time to time and this does not always mean cancer.  These symptoms are non-specific and poorly sensitive.  A woman with ovarian cancer may have several or none of these symptoms.   If ovarian cancer is suspected or is thought to be a high risk, testing may include CA-125 measurement, ultrasound imaging  or even surgical exploration.

Once diagnosed with ovarian cancer, information needs to be obtained about the amount of cancer present and whether or not it has spread elsewhere.  This is referred to as staging.  Ovarian cancer is unique in that tumor that has spread elsewhere in the abdomen does not mean it is untreatable.   With many types of cancer, disease that has spread to other parts of the body means that cure is near impossible.  Treatment of ovarian cancer that has been deemed treatable is aggressive with removal of the ovaries and large portions of internal fat.  A surgical technique known as cytoreductive surgery may be used in addition to intraperitoneal chemotherapy.

Once ovarian cancer has been diagnosed, a tumor marker such as CA-125 might be used to check for recurrent disease or to follow the disease.  Unfortunately, markers such as these are not good screening tests because they are very non-specific as well.

REFERENCES:

  1. www.cancer.gov/cancertopics/types/ovarian
  2. www.healthfinder.gov/news/newsstory.aspx?docID=656097
  3. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed.  Chapter75 .  New York, NY: Saunders.
  4. Katz VL, Lentz GM, Lobo RA, et al. (2007) Katz: Comprehensive Gynecology, 5th ed. Chapter 33.  Philadelphia, PA : Mosby-Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.