How Do I Know if I Have Symptoms of Ovarian Cancer?

Early warning symptoms of ovarian cancer may include:

• Abdominal bloating, pressure, and pain
• Feeling full quickly after eating
• Poor appetite
• Increase in urination frequency and urgency

Though many of these early signs of ovarian cancer can be signs of other conditions, symptoms of ovarian cancer will be persistent and may even worsen with time.

Symptoms usually get more severe as the tumor grows. By this time, cancer has usually spread outside of the ovaries, making it much harder to treat effectively. Later signs of ovarian cancer may include:

• Fatigue
• Back pain
• Menstrual irregularities (bleeding outside of your normal cycle)
• Pain during intercourse
• Loss of appetite
• Weight loss
• Changes in bowel habits (constipation)

Severe symptoms of ovarian cancer may include:

• Fluid build-up around the lungs (pleural effusion), which may also cause cough, chest pain, and shortness of breath
• Fluid build-up in the abdomen (ascites)
• Obstruction or blockage of the digestive tract (bowel obstruction)

Though many of the symptoms of ovarian cancer can resemble those of the perimenopause, one big difference is bleeding.

Usually, once you have reached menopause, you will no longer have your monthly period. If you experience bleeding during menopause, it could be a sign of ovarian cancer.

It is important to note that ovarian cancer is more common in women older than 60 years.

Because the signs of ovarian cancer are generally nonspecific and somewhat unclear in the early stages, it can be difficult to know when you need to seek medical treatment. Contact your doctor if:

• Your symptoms:
  • Are new to you
  • Occur frequently
  • Do not go away with changes in diet, exercise, or sleep
• Ovarian cancer or breast cancer runs in your family

Symptoms that last more than a couple of weeks are key to detecting ovarian cancer. About 15% of ovarian cancer cases are diagnosed in the early stages. Many women do not notice problems until a tumor is more advanced.

Several conditions can cause a mass or swelling in the pelvic area, which are usually detected during your routine check-up. An ovarian cyst is one of the most common causes of pelvic masses. Others include fibroids and endometriosis.

Growths can cause symptoms similar to those of ovarian cancer, such as:

• Pelvic pain
• Swelling or a bloated feeling in the abdomen
• Needing to pee often
• Nausea and vomiting
• Aching in your lower back and thighs
• Trouble emptying your bladder or bowels
• Pain during sex
• Weight gain with no clear cause
• Unusual vaginal bleeding
• Breast tenderness

Ovarian cancers start in the ovaries, which are made up of three types of cells. Each cell can develop into a different type of tumor:

• Epithelial ovarian tumors form in the outer layer of tissue on the ovaries. About 85%-90% of ovarian cancers are epithelial ovarian tumors.
• Stromal tumors grow in the hormone-producing cells. About 7% of ovarian cancers are stromal tumors.
• Germ cell tumors develop in the egg-producing cells. These are rare.

Although it is unclear what causes ovarian cancer, you may have a higher risk if you have the following risk factors:

• Family history of ovarian cancer
• Genetic mutations in BRCA1 or BRCA2
• Personal history of breast, uterine, or colon cancer
• Advanced age (most cases of ovarian cancer develop after menopause)
• Obesity
• Endometriosis
• Use of certain fertility drugs or hormone therapies
• No history of pregnancy
• Conceived after the age of 35 years
• Never carried a pregnancy to term

Ovarian cancer has a good prognosis if detected early.

Unlike other cancers like breast and colon cancer, there are no routine screenings for ovarian cancer. It is therefore important to report unusual or persistent symptoms to your doctor. 

If your doctor is concerned that you may have ovarian cancer, they will likely recommend a pelvic exam. As the tumor grows and presses against the bladder and rectum, irregularities can also be detected during a rectovaginal pelvic examination.

Tests used to diagnose ovarian cancer include:

• Transvaginal ultrasound (TVUS): Uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS cannot help determine whether tumors are cancerous.
• Abdominal and pelvic computed tomography (CT) scan: Helps diagnose the cause of pain in the abdominal or pelvic area.
• Magnetic resonance imaging (MRI) scans: Helps collect more information about areas that are difficult to see using a CT scan.
• Blood test to measure cancer antigen 125 (CA-125) levels: Used to assess treatment response for ovarian cancer and other gynecologic cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect CA-125 levels in the blood.
• Biopsy: Involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope for cancer cells
• Chest CT scan: Done to check for metastasis in the lungs.
• Positron emission tomography (PET) scan: Involves a special dye containing radioactive tracers that can either be swallowed or injected. Organs and tissues absorb the tracer, which allows a doctor to see how well those organs are working.

While these tests can help guide your doctor toward a diagnosis, a biopsy is the only way to confirm whether you have ovarian cancer. 

Once ovarian cancer has been diagnosed, your doctor will assign your cancer a stage:

• Stage I
  • Stage 1A: Cancer is limited or localized to one ovary.
  • Stage 1B: Cancer is in both ovaries.
  • Stage 1C: There are cancer cells on the outside of the ovary.
• Stage II: 
  • Stage 2A: Cancer has spread to the uterus or fallopian tubes.
  • Stage 2B: Cancer has spread to the bladder or rectum.
• Stage III
  • Stage 3A: Cancer has spread microscopically beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
  • Stage 3B: Cancer has spread beyond the pelvis to the lining of the abdomen and are visible to the naked eye but measure less than 2 cm.
  • Stage 3C: Deposits of cancer larger than 3/4 of an inch are seen on the abdomen or outside the spleen or liver.
• Stage IV:
  • Stage 4A: Cancer cells are in the fluid around the lungs.
  • Stage 4B: Cancer cells have reached the inside of the spleen or liver or other distant organs, such as the skin or brain.

Treatment for ovarian cancer depends on the stage and typically involves two or more of the following methods:

Surgery

Surgery is the main treatment for ovarian cancer. The goal of surgery is to remove the tumor, but a hysterectomy or complete removal of the uterus is often necessary. Your doctor may recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.

Targeted therapy

Targeted therapies specifically attack cancer cells while avoiding damage to normal cells in the body.

Newer targeted therapies to treat advanced epithelial ovarian cancer include poly-ADP ribose polymerase (PARP) inhibitors. These drugs block an enzyme used by cells to repair damage to their DNA.

The first PARP inhibitor was approved in 2014 to use in advanced ovarian cancer that had been treated previously with three lines of chemotherapy (meaning at least two recurrences). However, for those with advanced ovarian cancers, PARP inhibitors may be offered alongside chemotherapy. The three PARP inhibitors currently available include:

• Lynparza (olaparib)
• Zejula (niraparib)
• Rubraca (rucaparib)

Avastin (bevacizumab) has been used with chemotherapy following surgery.

Individuals who have BRCA1 or BRCA2 genes may have slightly different targeted therapy options because BRCA genes are involved in DNA repair and may be more sensitive to anticancer agents that work by damaging DNA.

Hormone therapy

Hormone therapy uses drugs to block the effects of the hormone estrogen on ovarian cancer cells. Some ovarian cancer cells use estrogen to help them grow, so blocking estrogen may help control cancer progression.

Hormone therapy might be a treatment option for some types of slow-growing ovarian cancers. It could be an option if cancer comes back after initial treatments.

Immunotherapy

Immunotherapy uses the immune system to fight cancer cells. The immune system may not attack cancer cells because they produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

There are no proven ways to prevent  ovarian cancer. However, factors that have been shown to lower the risk of developing ovarian cancer include:

• Oral birth control pills
• Pregnancy
• Breastfeeding
• Certain surgical procedures on the reproductive organs (such as tubal ligation or hysterectomy)

Knowing your family history can help you prepare for any heightened risk of developing ovarian cancer. If this type of cancer runs in your family, talk to your doctor.