Ovarian cancer is sometimes called a “silent” cancer, but it is not always silent. Many women do have symptoms, even in earlier stages. They are simply easy to mistake for everyday digestive or bladder problems. Because there is no reliable screening test for women at average risk, knowing the warning signs and your own risk is especially important.
What ovarian cancer is
Ovarian cancer includes cancers that start in the ovaries, the fallopian tubes or the lining of the abdomen (peritoneum). Researchers now believe many of the most common type, high-grade serous carcinoma, actually begin in the fallopian tubes. Ovarian cancer is less common than breast cancer but more often diagnosed at a later stage.
Symptoms to watch for
The most common symptoms are:
- Bloating or a swollen abdomen
- Pelvic or abdominal pain
- Feeling full quickly or difficulty eating
- Urinary urgency or frequency
Other possible symptoms include:
- Fatigue
- Indigestion or nausea
- Back pain
- Pain during sex
- Constipation or other changes in bowel habits
- Changes in menstrual periods or bleeding after menopause
- Unexplained weight loss or gain
The key is persistence. These symptoms are common and usually have harmless causes, but see a doctor if they are new, happen almost daily, and last more than two to three weeks, especially if you are over 50 or have a family history of ovarian or breast cancer.
Risk factors
- Age: most cases occur after menopause
- Inherited gene changes: BRCA1 and BRCA2 mutations significantly raise lifetime risk, and Lynch syndrome also increases risk
- Family history of ovarian, breast or colorectal cancer
- Personal history of breast cancer
- Endometriosis
- Never having been pregnant
- Hormone therapy after menopause (estrogen alone, used for many years)
- Obesity
Factors linked to lower risk include using birth control pills for several years, pregnancy, breastfeeding, and having the fallopian tubes removed or tied.
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Why there is no routine screening
Large studies of screening women at average risk with transvaginal ultrasound and the CA-125 blood test did not reduce deaths from ovarian cancer and led to unnecessary surgery from false alarms. For this reason, the U.S. Preventive Services Task Force recommends against routine screening for women at average risk who have no symptoms.
Women at high risk because of inherited gene changes need a personalized plan with a specialist.
How ovarian cancer is diagnosed
If symptoms suggest ovarian cancer, a doctor may arrange:
- A pelvic exam
- Transvaginal ultrasound to look at the ovaries and tubes
- CA-125 blood test. It can be raised in ovarian cancer but also in many benign conditions, such as endometriosis, fibroids and menstruation, so it is used alongside imaging rather than on its own
- CT or MRI scans to see whether disease has spread
- Surgery and biopsy to confirm the diagnosis and stage
Ideally, surgery should be performed by a gynecologic oncologist, a surgeon specializing in gynecologic cancers. Research shows outcomes are better when specialist surgeons perform the initial operation.
Treatment
Treatment usually combines:
- Surgery to remove as much cancer as possible, often including the ovaries, fallopian tubes, uterus and nearby tissue
- Chemotherapy, usually platinum-based, either after surgery or before it to shrink tumors
- Maintenance therapy, such as PARP inhibitors, which have improved outcomes particularly for women with BRCA mutations or certain tumor characteristics
- Targeted therapies and clinical trials for recurrent disease
All women diagnosed with ovarian cancer are advised to have genetic testing, because the results can guide treatment and help relatives understand their own risk.
Reducing risk for high-risk women
For women with BRCA1 or BRCA2 mutations, the most effective risk-reducing step is surgery to remove the ovaries and fallopian tubes, typically recommended in the late 30s to mid 40s depending on the gene and whether childbearing is complete. Some women at average risk who are already having pelvic surgery, such as a hysterectomy or tubal sterilization, may choose to have their fallopian tubes removed (salpingectomy) to lower their future risk. Discuss options with a genetic counselor and gynecologist.
The bottom line
Ovarian cancer often causes bloating, pelvic pain, feeling full quickly and urinary symptoms that persist for weeks. If you notice these almost every day for more than a few weeks, see a doctor. If ovarian or breast cancer runs in your family, ask about genetic counseling, because knowing your risk opens the door to prevention.
This article is for general information and does not replace medical advice.