Detecting Ovarian Cancer

Early detection is key, but what are the symptoms and how is it diagnosed?

Medically reviewed in January 2021

Your ovaries lie deep within your pelvis, which makes disease detection tricky. Early screening methods for ovarian cancer have so far proved unreliable, 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.

As a result, the vast majority of ovarian cancers are diagnosed when the cancer is in an advanced stage, at which point the chances of survival are significantly reduced. In a comparison of survival rates among women with one of the most common types of ovarian cancer, fewer than 20% of women diagnosed at an advanced stage (stage IV) survived more than 5 years after diagnosis. In contrast, 89% of women diagnosed at the earliest stage (stage I) did survive at least 5 years.

The current statistics may be unnerving, but the more we learn about ovarian cancer, the brighter the future looks. Research is under way to develop new, more accurate methods of detecting early ovarian cancer. And the disease may not be as silent as once believed.

Four Significant Symptoms
The following four symptoms are considered the most reliable early warning signs of ovarian cancer:

  • Abdominal pain
  • Persistent bloating or abdominal distension
  • Abnormal vaginal bleeding
  • Early satiety (feeling full quickly)

Additional symptoms associated with ovarian cancer, though not necessarily at an early stage, include:

  • Pelvic or lower back pain
  • Nausea
  • Unexplained weight loss
  • Fatigue
  • Urinary urgency or increased frequency
  • Constipation
  • Diarrhea
  • Menstrual irregularity
  • Painful intercourse
  • Abdominal mass

Yes, many of these symptoms are fairly common and are also associated with other less serious conditions, such as bladder infections and irritable bowel syndrome (IBS). So keep in mind that if you have some of these symptoms, it does not automatically mean that you have ovarian cancer.

Rather, if you experience these symptoms, and they don't subside or improve with normal treatment, use this article as a starting point for further discussion and exploration with your doctor.

Pay particular attention to symptoms that are unusual for you, severe, and frequent (occurring almost every day) and that have continued for a few weeks or more. Studies suggest that these characteristics may indicate an ovarian mass.

A diagnosis of ovarian cancer is not made based on symptoms alone. But by defining symptoms and raising awareness, women may be encouraged to listen more closely to their bodies and establish an ongoing communication with their physicians.

Voice Your Concerns
Screening for ovarian cancer is not yet a routine part of typical preventive healthcare, partly because no screening methods have been shown to be reliably accurate. But if you have symptoms you're concerned about, talk to your gynecologist. He or she may perform a pelvic exam to feel your ovaries for anything unusual. But remember, most early ovarian tumors are extremely difficult to feel.

If your symptoms persist, occur in combination, or get worse, go back to your gynecologist. Don't ignore unusual or painful symptoms. If you feel you're not being taken seriously or your care is not as thorough as you'd like, you may want to consider getting a second opinion.

If you have symptoms and a strong family history of breast or ovarian cancer, some experts suggest a pelvic or transvaginal ultrasound and a CA-125 blood test in addition to a manual pelvic exam.

The Future of Testing
The current blood test used to screen for ovarian cancer measures the level of CA-125, a protein produced by ovarian cancer cells. The test is not very sensitive or specific, so results are not always accurate.

Elevated levels of CA-125 could be a sign of ovarian cancer but could also be caused by something else, such as uterine fibroids, endometriosis, pregnancy, infection, or liver problems. Several studies are looking at ways to improve the performance of this test, but it is still used if an ovarian mass is suspected.

Trials are also under way to discover whether other kinds of blood tests may be helpful in detecting ovarian cancer, such as proteomics tests, which attempt to detect patterns of proteins in the blood that are produced by cancer cells in the body. Initial trials are using these tests to detect ovarian cancer recurrence. Eventually, researchers believe that the test may be useful for women at high risk for ovarian cancer, such as women with a family history of the disease.

Other methods of screening may one day involve analyzing women's genes. Researchers recently discovered that the genes of women with ovarian cancer have often undergone hypermethylation, a process that cancer cells use to turn off genes that suppress tumor development. It appears that hypermethylation is a very specific marker for cancer cells, and, if confirmed in larger studies, hypermethylation-based screening of blood serum may be useful in ovarian cancer diagnosis.

Getting Closer
It may be that the title of silent killer is not appropriate for ovarian cancer after all. Research shows there are early warning signs -- and we need to pay attention to them. It also appears that researchers are getting closer to finding better methods to detect ovarian cancer in the early stages, when chances of survival are greatest.

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 doctor to understand the latest diagnostic methods that are available and appropriate for you.

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