Symptoms of Ovarian Cancer

Ovarian cancer has been nicknamed the "silent killer." This is because there are said to be few signs and symptoms in the early stages of the disease.

Recently, however, researchers have found that people with early stage ovarian cancer do often have symptoms. Unfortunately, these symptoms are usually subtle, vague, and easily dismissed as having some other cause.

Unfortunately, there is no screening test for ovarian cancer at this time. Most cases are only found in advanced stages.

This article discusses early and later symptoms of ovarian cancer. It also looks at some of the complications of ovarian cancer, and when you should see a doctor.

Early Symptoms of Ovarian Cancer

After an ovarian cancer diagnosis, many patients look back and realize they had symptoms they did not recognize. The symptoms were just too mild or vague to prompt a visit to the doctor.

Early detection is crucial. If you have any of these symptoms, mention them to your doctor.

Abdominal Bloating

Most people notice occasional abdominal bloating and swelling. This is especially common in the premenstrual period or after eating a large meal.

Bloating that is persistent, though, is a possible warning sign of ovarian cancer.

This type of bloating may vary in degree from mild to severe. It often occurs on a daily basis and can worsen with time. You may also have mild indigestion. 

This symptom can be subtle. Your clothes may feel tight around your waistline, even when you haven't gained any weight.

Look in the mirror. You may be able to see visible bloating. Some people may even develop stretch marks. This can happen especially if you have never been pregnant.

Bloating with early ovarian cancer is often dismissed as something else. You may think it's related to age, menopause, or gaining a few pounds. Remember, though, if you feel bloated for more than a day or two it is a reason for concern.

Pelvic Pain or Pressure

Pelvic pain that feels like menstrual cramps is another symptom of early ovarian cancer. Like bloating, occasional pelvic pain is common, especially during menstruation. This is why this symptom may be overlooked.

The pain may be on one side of your pelvis. It can also be diffuse and felt all over your pelvis. 

Feeling Full Quickly With Eating

Many people with early ovarian cancer notice they feel full more quickly than normal after eating an average size meal. This sensation may also occur between meals. There may or may not also be gas and indigestion.

Weight loss is common with more advanced ovarian cancers. As an early symptom, it can be related to this sense of fullness.

Urinary Frequency

Another early symptom of ovarian cancer is more frequent urination. There may also be a sense of urgency when you need to go.

This may be related to a tumor putting pressure on the bladder. It can also be related to hormonal changes caused by some tumors.

Some patients also feel a strong need to urinate, but upon sitting down realize they do not need to go.

Advanced Stage Symptoms of Ovarian Cancer

Many other symptoms of ovarian cancer happen only after the tumor has reached an advanced stage. Again, there are many potential causes of these symptoms. This is why it is important to see your doctor.

Changes in Bowel Habits

This is the most important symptom to note. It may also be a symptom of colon cancer.

Changes in bowels habits can include both constipation and diarrhea. Stools may also become skinnier. This is because the tumor puts pressure on the bowel.

In later stages of ovarian cancer, tumors may cause bowel obstruction. Symptoms include:

• Worsening and crampy abdominal pain
• Vomiting
• Diarrhea

Pain With Intercourse

Pain during intercourse is also called dyspareunia. It may occur with ovarian cancer. It can also be a 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. The pain is similar to menstrual cramps. It may begin with intercourse and continue for some time afterward.

Discuss any discomfort or pain during sexual activity with your doctor.

Back Pain

Pain may occur in the lower back or flank region. The flank is the side of the body, roughly between the rib cage and the hip.

The pain can feel similar to menstrual pain or the early stages of labor. If you have lower back pain that is not related to activities such as heavy lifting, talk to your doctor.

Unintentional Weight Loss or Weight Gain

Weight gain from ovarian cancer often happens quickly. This is due to the accumulation of fluid in the abdomen.

Weight loss may occur for a combination of reasons. The early sensation of fullness and loss of appetite may cause weight loss.

With more advanced cancers, cancer cachexia may contribute. This is a syndrome of weight loss, loss of muscle mass, and loss of appetite. 

An example of unexplained weight loss would be a 150-pound woman losing 7.5 pounds over a six-month period without diet or exercise.

Unintentional weight loss should always be evaluated. Besides ovarian cancer, there are other serious conditions that can cause this.

Studies have found that over a third of people who have unexpected weight loss have an underlying cancer of some form. 

Fluid in the Abdomen (Ascites)

Ascites is another form of abdominal swelling that can occur in more advanced stages of ovarian cancer. This is when large amounts of fluid accumulate in the abdomen.

Ascites can happen when the cancer spreads to the abdominal cavity and liver. The fluid needs to be drained.

Ascites can also lead to shortness of breath If the fluid pushes upward on the lungs.

Fatigue

Fatigue is the most common cancer symptom. It can also be a symptom of a wide range of other medical conditions, though.

Cancer-related fatigue tends to differ from ordinary tiredness. It doesn't go away after a good night of sleep or a cup of coffee.

As ovarian cancer progresses, cancer cells compete with healthy cells for energy. This is what causes fatigue.

Symptoms of Germ Cell or Stromal Cell Tumors

Younger ovarian cancer patients often have germ cell tumors or sex cord stromal tumors. These patients may have the symptoms described above but may also have other symptoms.

Masculinization

Tumors that produce male-type hormones may result in masculinization. Symptoms may include 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 may also occur. It may be clear, yellow, or blood-tinged. There may also be bleeding similar to a period.

Abnormal vaginal bleeding is a common symptom of stromal cell tumors. It is associated with the female hormone estrogen secreted by these tumors.

Precocious Puberty

Early puberty is called precocious puberty. It may occur in girls due to estrogen-secreting tumors. It is most often seen with germ cell and stromal cell tumors.

Symptoms may also include:

• Early breast development
• Development of pubic hair
• Early onset of the first period

Severe Pelvic Pain

Mild pelvic pain and pressure are common early symptoms of ovarian cancer. Pain that is severe could be a different kind of ovarian tumor symptom.

Ovarian tumors can cause the ovary to twist around the fallopian tube. This is known as torsion. It is more common with germ cell and stromal cell tumors.

When this happens, the blood vessels that bring blood to the ovary may be cut off. The lack of blood supply can cause severe pain, bleeding, and often infection.

Pelvic Mass

A pelvic mass is more common with germ cell and stromal cell tumors in girls and young females. It may even occasionally be the first sign of cancer.

Ovarian Cancer Complications

Ovarian cancer can cause other complications. This happens most often when the cancer spreads to the abdomen and lungs.

Many people have few, if any, of these complications. Still, it is important to be aware of the possibilities and seek medical attention if you have any symptoms.

Bowel Obstruction

Bowel obstructions may occur when cancer spreads to the abdomen and pelvis. It may also happen because of scar tissue that forms after abdominal or pelvic surgery. This includes surgery for ovarian cancer.

Scar tissue can lead to kinks and twists in the bowel. This can cause an obstruction. Symptoms of a bowel obstruction include:

• Severe, crampy abdominal pain
• Vomiting

Surgery is often needed to remove the affected parts of the intestine. After surgery, feeding is often temporarily done through a tube. This gives the bowel time to recover.

Perforated Colon

Ovarian cancer tends to spread to the wall of the intestines. As it grows, tissue can weaken. This may set the stage for bowel perforation.

When the bowel is perforated, bowel contents leak into the abdominal cavity. This causes an infection called peritonitis. Surgery is often needed to bypass the diseased area of the bowel.

Urinary Blockage or Urinary Retention

Ovarian cancer can spread in the pelvis. It may block the tubes that travel from the kidneys to the bladder. These tubes are called ureters.

If both ureters are blocked, urine output drops. If only one ureter is blocked, there could be severe pain. There may also be no pain, depending on the location of the blockage.

A stent may be placed to resolve the blockage. This is a small tube that holds the ureter open.

Pleural Effusion

When the cancer spreads to the lungs or the chest region, fluid may build up between the membranes that line the lungs. These membranes are called pleura.

Sometimes this fluid contains cancer cells. Pleura that contains cancer cells is called malignant pleural effusion.

A procedure called thoracentesis can be used to drain the fluid. During this procedure, a needle is placed through the skin on the chest into the pleural cavity.

A stent can be placed to allow continual drainage. Pleurodesis is another option. During this procedure, a chemical is placed between the layers. This causes the membranes to scar together, preventing additional fluid build up.

Bone Pain

When cancer spreads to the bones it can cause pain. This pain can be severe. Fortunately, there are treatments that can help, such as:

• Bone-modifying drugs
• Radiation therapy

When to See a Healthcare Provider

Early symptoms of ovarian cancer, when present, are often vague and subtle. For each of these symptoms, there are usually other, less harmful conditions that could be the cause.

See a doctor for anything that seems not quite right and lasts for more than a few days. This is especially important if your symptoms are similar to what you see above.

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If your exam is normal, but your body is still telling you something is wrong, listen. Follow-up or get a second opinion.

In the early stages, ovarian cancer can be cured or treated to allow for a very low probability of returning.

Summary

Early symptoms of ovarian cancer can be vague and mild. Pay attention if you have persistent bloating or pelvic pain or pressure, if you feel full quickly after eating, or if you urinate more frequently or urgently.

Later stage ovarian cancer symptoms may include changes in bowel habits, pain with intercourse, back pain, unintentional weight loss, fluid in the abdomen, or fatigue.

Some types of ovarian cancer may cause other symptoms, such as masculinization, abnormal bleeding, early puberty, or severe pelvic pain. A pelvic mass is another common symptom of these types of cancers.

Complications of ovarian cancer may include bowel obstruction, perforated colon, urinary problems, fluid in the membranes of the lungs, and bone pain.

See a doctor if you have any signs of ovarian cancer, even if they are subtle. Your symptoms are likely to have other causes. If they are related to ovarian cancer, though, early detection can help you get life-saving treatment.