Updated on June 15, 2023.
Ovarian cancer is the fifth leading cause of cancer deaths in women, according to the National Cancer Institute (NCI). Yet screening tests have not been proven to lower the risk of death from the disease. That’s part of why education and awareness are critical ways you can help protect yourself.
Understanding ovarian cancer
Your ovaries lie deep within your pelvis, which makes disease detection tricky. And although routine pelvic exams include a check for anything that feels out of the ordinary, early-stage ovarian tumors easily escape detection because they’re difficult to feel. In addition, ovarian cancer has a reputation for being “silent,” meaning symptoms tend to be either vague or nonexistent until the disease has spread.
According to the Centers for Disease Control and Prevention (CDC), the best way to detect ovarian cancer early is to know the signs and be aware of changes in your body. If you notice any changes that are unusual for you and that could be a symptom of ovarian cancer, it’s important to check in with your healthcare provider (HCP) to rule it out.
If ovarian cancer is detected locally, before it has spread, the five-year survival rate is about 92 percent, according to the NCI. Even if it has spread, if it’s still confined to the pelvic area, the five-year survival rate is around 73 percent. Unfortunately, only 24 percent of cases of ovarian cancer are found in these early, more treatable stages. The vast majority of ovarian cancers are diagnosed when the cancer has spread to distant parts of the body, at which point the chances of survival are significantly reduced. About 31 percent of patients diagnosed at this point survive more than five years after diagnosis.
Fortunately, the more we learn about ovarian cancer, the brighter the future looks. Research is under way to develop new, more accurate methods of detecting ovarian cancer early.
Four significant symptoms
The following four symptoms are the most common early warning signs of ovarian cancer, according to the American Cancer Society (ACS):
- Abdominal or pelvic pain
- Bloating or abdominal distension
- Early satiety (feeling full quickly) or difficulty eating
- Urinary urgency or increased frequency
Keep in mind that these are all common symptoms of other health conditions. If you experience some of these issues, it does not automatically mean that you have ovarian cancer.
It’s important to take note if these symptoms are new, persistent, unusual for you, happen more often, or are more intense than normal. The ACS recommends counting any occurrences of these symptoms. If they are new to you and happen more than 12 times a month, it’s time to see your HCP.
Additional symptoms associated with ovarian cancer can include:
- Abnormal vaginal bleeding
- Back pain
- An upset stomach (such as diarrhea and nausea)
- Fatigue
- Menstrual irregularity
- Painful intercourse
- Swelling of the abdomen with weight loss
A diagnosis of ovarian cancer is not made based on symptoms alone. But by defining symptoms and raising awareness, people with ovaries may be encouraged to listen more closely to their bodies and establish an ongoing communication with their HCPs.
Testing for ovarian cancer
The tests used most often to look for early ovarian cancer are done in addition to a manual pelvic exam. They are:
- A blood test that measures the level of CA-125, a protein produced by ovarian cancer cells
- A transvaginal ultrasound
Elevated levels of CA-125 could be a sign of ovarian cancer but may also be caused by something else, such as pelvic inflammatory disease or endometriosis. What’s more, not everyone with ovarian cancer has high levels of CA-125.
A transvaginal ultrasound (TVS) can detect a mass in the ovary, but most of the time these masses are not cancerous.
The two tests carry a lot of uncertainty, although a 2019 study published in Current Oncology Reports found that for some patients, tracking CA-125 over time (in combination with TVS) detects more early-stage disease. They are not shown to reduce ovarian cancer deaths, however, and are not used for routine ovarian cancer screening.
Be your own advocate
Screening for ovarian cancer is not yet a routine part of preventive health care. But if you have concerning symptoms, in addition to some of the following risk factors identified by the CDC, make an appointment with your HCP right away:
- You’re middle-aged or older
- You have a family history of ovarian cancer in close family members on either side of your family
- You have a genetic mutation called BRCA1 or BRCA2, or one that is associated with Lynch syndrome
- You’ve had colon, breast, or uterine cancer
- You have endometriosis
- You have an Eastern European or Ashkenazi Jewish background
- You’ve never given birth or have had trouble getting pregnant
- You’ve taken estrogen by itself for 10 or more years
Research shows that ovarian cancer may often originate in the fallopian tubes. If you will be undergoing tubal ligation to prevent pregnancy or are having another gynecologic surgical procedure, you may want to talk with your HCP about including a salpingectomy, or complete removal of the tubes, rather than simply tying them off. This procedure can lower your risk of ovarian cancer.
Don't ignore unusual or painful symptoms. And if you feel you're not being taken seriously or your care is not as thorough as you'd like, consider getting a second opinion.
The future of testing
Scientists are researching and developing ways of making ovarian cancer screening more sensitive and accurate. Here are the main avenues of research:
Blood biomarkers are molecules found in blood that can indicate a health condition. They may be helpful in detecting early-stage ovarian cancer, both by themselves and together with CA-125. One biomarker in particular, a protein called HE4, when combined with CA-125 has been shown to significantly enhance sensitivity for figuring out whether a mass is benign or cancerous.
Autoantibodies are proteins made by our immune system that attack our own cells by mistake. They are stimulated when even small volumes of cancer are present, so they could be helpful signifiers. Testing for panels or groups of autoantibodies is currently being looked at as a screening tool to complement CA-125 and TVS.
MicroRNAs float around in body fluids and change based on the state of health. Early research indicates they may be potential biomarkers.
Circulating tumor DNA (ctDNA) testing might also be a way of detecting tumors. However, this method can give false positives and isn’t as helpful in the early days of the development of a cancer.
The genes of people with ovarian cancer have often undergone DNA hypermethylation, a process that cancer cells use to turn off genes that suppress tumor development. It seems that hypermethylation is a very specific marker for cancer cells, and in one 2017 study published in Genome Medicine screening for it predicted cancer correctly in more than 50 percent of cases. If confirmed in larger studies, DNA methylation-based screening of blood serum may be useful in ovarian cancer diagnosis.
Since ovarian tumors can stay very small (less than three millimeters) for several years, they can be hard to see with TVS. This is where other imaging technology might be able to help, including magnetic resonance imaging (MRI), magnetic relaxometry (MRX), and superconducting quantum interference devices (SQUIDs). MRI and MRX work can detect magnetic nanoparticles.
As diagnostic tools for early detection are further refined, you can turn up the volume on this silent disease by learning to recognize possible symptoms, knowing your risk factors, and working with your HCP to understand the latest diagnostic methods that are available and appropriate for you.
