Symptoms of Ovarian Cancer

Ovarian cancer has been nicknamed the "silent killer" because there are said to be few signs and symptoms in the early stages of the disease. Recently, however, researchers have found that women actually do often have symptoms, such as abdominal bloating, feeling full rapidly when eating, pelvic pain, and urinary frequency, but they are usually subtle, vague, and easily dismissed as being due to something else.

Getting a medical opinion about any such symptoms is essential to catching ovarian cancer early because, unfortunately, there is no screening test for the disease at this time and most cases are only found in their advanced stages.

Upon being informed of an ovarian cancer diagnosis and asked about a history of related symptoms, many women look back and realize that they had such symptoms for some time—they were just too ambiguous or mild to prompt a discussion with a doctor. 

Researchers have noted that four symptoms, in particular, may be present in the early stages of the disease. If you experience any of these, speak with your doctor.

Abdominal Bloating

Most people notice abdominal bloating and swelling on occasion, especially in the premenstrual period or after eating a large meal. But bloating that is persistent is a possible warning sign of ovarian cancer. The degree of bloating may vary from mild to severe, but often occurs on a daily basis and can worsen with time. Mild indigestion may be present as well. 

Since this symptom is subtle, pay attention if your clothes feel tight around your waistline, even when you haven't gained any weight. Take a peek in the mirror. You may not just feel bloated but notice visible bloating in the mirror. Some women develop stretch marks, especially if they have never been pregnant. Most of the time, bloating with early ovarian cancer is dismissed as being related to age, menopause, or gaining a few pounds. Feeling bloated for more than a day or two is a reason for concern.

Pelvic Pain or Pressure

Pelvic pain that feels like menstrual cramps are also common early on with ovarian cancer. As with bloating, many women normally have pelvic pain at times, especially during their periods. But if the pelvic pain that persists, especially if it is accompanied by a sense of pelvic pressure, is a reason to see your doctor. The pain may be localized to one side, but can also be diffuse and felt all over your pelvis. 

Feeling Full Quickly With Eating

Many people with early ovarian cancer note that they feel full more quickly after eating an average size meal than they did in the past. They may also continue to have this sensation between meals. This may or not be accompanied by gas and indigestion. Weight loss is common with more advanced ovarian cancers but may also be an early symptom related to this sense of fullness in the abdominal or pelvic region.

Urinary Frequency

Having to urinate more frequently or feeling a sense of urgency when you need to go may occur early on with ovarian cancer. This may be related not only to pressure on the bladder from a tumor but also hormonal changes caused by some tumors. Some women also feel a strong need to urinate, but upon sitting down realize that they do not need to go.

There are other symptoms commonly found with ovarian cancer, but many of these occur only after a tumor has reached an advanced stage. Again, there are many potential causes of these, and it is important to see your doctor to determine the cause.

Changes in Bowel Habits

This is the most important symptom to note (for colon cancer, too). Changes in bowels habits can include both constipation and diarrhea. When a tumor places pressure on the bowel, stools may become thinner as well. In the later stages of ovarian cancer, tumors on the bowel and in the abdomen may result in a bowel obstruction. Symptoms of that often include worsening and crampy abdominal pain, vomiting, and diarrhea.

Pain With Intercourse

Pain during intercourse, also called dyspareunia, may occur with ovarian cancer but is also a common symptom of other conditions such as pelvic inflammatory disease. This pain is often felt on one side more than the other but can be generalized. Pain similar to menstrual cramps may also begin with intercourse and continue for some time afterward. Not only can this symptom be a warning sign of a number of conditions, but it can cause emotional and relationship difficulties as well. Talk with your doctor if you note any discomfort during or after sex.

Back Pain

Pain may occur in the lower back or flank region (the side of the body, roughly between the rib cage and the hip) and feel similar to menstrual pain or the early stages of labor. Lower backache not related to activities such as heavy lifting is worth noting.

Unintentional Weight Loss or Weight Gain

When weight gain occurs, it often happens fairly rapidly due to the accumulation of fluid in the abdomen (with ascites, noted below).

Weight loss may occur for a combination of reasons, including the early sensation of fullness and loss of appetite. With more advanced cancers, cancer cachexia—a syndrome of weight loss, loss of muscle mass, and loss of appetite—may be at play. 

Unintentional weight loss is defined as the loss of 5 percent or more of body weight over a six to 12-month period. An example of unexplained weight loss would be a 150-pound woman losing 7.5 pounds over a six-month period without a change in her diet or exercise regimen.

Unintentional weight loss should always be evaluated, as there are other serious conditions that can cause this symptom in addition to ovarian cancer. Studies have found that over a third of people who experience unexpected weight loss have an underlying cancer of some form. 

Fluid Collection in the Abdomen (Ascites)

Another form of abdominal swelling can occur in more advanced stages of ovarian cancer. With metastases to the abdominal cavity and liver, large amounts of fluid may accumulate and require drainage. This is referred to as ascites. Ascites can also lead to shortness of breath if the fluid pushes upward on the lungs.

Fatigue

Fatigue is the most common cancer symptom but can be a symptom of a wide range of medical conditions. The fatigue seen with cancer tends to differ from ordinary tiredness; it doesn't respond to a good night of sleep or a good cup of coffee. As ovarian cancer progresses, cancer cells compete with healthy cells for energy, leading to fatigue.

Germ cell tumors and sex cord stromal tumors, the types of ovarian cancers often found in younger women, may have the symptoms described above but may have additional symptoms as well. Some of these include:

Masculinization

Tumors that produce male-type hormones may result in masculinization, with signs such as a lowering of the voice and male pattern hair growth. These symptoms are often found in the subtype of stromal ovarian tumors called Sertoli-Leydig cell tumors.

Vaginal Discharge or Bleeding

Vaginal discharge (clear, yellow, or blood-tinged) and/or bleeding similar to a period may also occur. Symptoms of bleeding before menarche (the first period), after menopause, or mid-cycle in women of reproductive age should be brought to a doctor's attention as there are many potential causes. Abnormal vaginal bleeding is a common symptom of stromal cell tumors and is associated with estrogen secreted by these tumors.

Precocious Puberty

Early (precocious) puberty may also occur due to estrogen-secreting tumors and is most often seen with germ cell and stromal cell tumors. Symptoms may include early breast development, development of pubic hair, or early menses in girls.

Severe Pelvic Pain

Mild pelvic pain and pressure are common early symptoms of ovarian cancer, but pain that is severe could herald an ovarian tumor in a different way. Ovarian tumors, especially germ cell and stromal cell tumors, can cause the ovary to twist around the fallopian tube (torsion). When this happens, the blood vessels that bring blood to the ovary may be cut off, and the lack of blood supply can result in severe pain, bleeding, and often infection.

Pelvic Mass

More common with germ cell and stromal cell tumors in girls and young women, a pelvic mass may occasionally be the first sign of cancer. Ovarian tumors (like cysts) can sometimes become quite large before they cause many symptoms. 

In addition to the symptoms above, ovarian cancer can sometimes lead to complications, most often due to metastases to the abdomen and lungs. Keep in mind that many people have few, if any, of these complications. Still, it's important to be aware of some of the possibilities and seek medical attention if you have any symptoms. Some of these include:

Bowel Obstruction

Unfortunately, bowel obstructions may occur both due to metastases in the abdomen and pelvis, and adhesions (scar tissue) formed after abdominal or pelvic surgery (including surgery for ovarian cancer). This scar tissue can lead to kinks and twists in the bowel, causing an obstruction.

Symptoms often include severe, crampy abdominal pain and vomiting. Surgery is often needed to remove the affected parts of the intestine. When this occurs, a gastric tube or nasogastric tube is often needed for feeding while the bowel recovers.

Perforated Colon

Ovarian cancer tends to metastasize to the wall of the intestines and grow. Tissue can weaken, setting the stage for bowel perforation that results in the bowel contents leaking into the abdominal cavity and causing an infection (peritonitis). Surgery is often needed to bypass the diseased area of the bowel.

Blockage of a Ureter/Urinary Retention

Ovarian cancers can spread in the pelvis, blocking the tubes that travel from the kidneys to the bladder (the ureters). If both ureters are blocked, urine output will drop. If only one ureter is blocked, there may be no symptoms or there could be severe pain, depending on the location of the blockage. Placement of a stent to hold the ureter open may be needed to resolve the blockage.

Pleural Effusion

With metastases to the lungs or the chest region, fluid may build up between the membranes that line the lungs (the pleura). Sometimes this fluid contains cancer cells and is referred to as a malignant pleural effusion.

A procedure called a thoracentesis (placing a needle through the skin on the chest into the pleural cavity) can be used to drain the fluid. Pleural effusions often recur with cancer and, if this happens, a stent can be placed to allow continual drainage; as an alternative, a chemical might be placed between the layers to cause the membranes to scar together so that further fluid can't build up (pleurodesis).

Bone Pain

Bone pain related to bone metastases can be severe, but there are many options including bone-modifying drugs and radiation therapy that can help.

A 2016 review of studies found that the symptoms that had the highest likelihood of indicating ovarian cancer included an abdominal mass, abdominal distention (or increased girth), abdominal or pelvic pain, abdominal or pelvic bloating, and loss of appetite.

That said, remember that the early symptoms of ovarian cancer, when present, are often vague and subtle, and with each of these symptoms, there are usually other, less harmful conditions that could be the cause. Anything that seems not quite right and that lasts for more than a few days, especially if it is similar to what you see above, is worth discussing.

If your exam is normal, but your body is still telling you that something is wrong, listen. Follow-up again or get a second opinion. Ovarian cancer is one of the cancers that can be cured or at least treated to allow for a very low probability of returning when found in its early stages.