Since the signs can be difficult to recognize, ovarian cancer is often diagnosed after it's already reached a late stage and has spread to other organs. Your symptoms might be vague or mimic those of other common conditions like premenstrual syndrome (PMS), which could cause you to brush them off. Here are the ovarian cancer red flags every woman should know about, plus when to call your doctor.
What are the signs of ovarian cancer?
“The most common symptom I see in women is pelvic discomfort and pelvic pain that varies in intensity,” says Victor Dabelea, MD, a generalist obstetrician and gynecologist (OBGYN) affiliated with Presbyterian/Saint Luke’s Medical Center in Denver, Colorado. “It may be just mild pelvic pain that’s on and off. At the other end of the spectrum, there may be severe pelvic or abdominal pain that brings a woman initially to the emergency room.”
Another common symptom is feeling bloated. You may have difficulty eating or feel full too quickly, or you may feel that the size of your abdomen is increasing—even though you’re eating less or may actually be losing weight.
Other symptoms of ovarian cancer include:
- Fatigue or exhaustion
- Back pain
- Painful sex
- Constipation or diarrhea
Ovarian cancer can sometimes act like a urinary tract infection (UTI), as well, making you feel like you need to urinate frequently or urgently. Some women also experience vaginal bleeding that’s out of character for their menstrual cycle, or that comes after menopause. If you have pelvic pain that comes and goes, or occasional spotting, keep track of how often it’s happening. Mark the events down in your calendar or smartphone and share the information with your doctor. This is especially true if you experience the symptoms more than 12 times a month. Be sure to tell your doctor if you feel bloated nearly every day for three weeks or more.
When to see your doctor
“The best advice is to see either your primary care doctor or OBGYN if you have any of the symptoms of ovarian cancer,” says Dr. Dabelea. When in doubt, it’s better to get checked out than to dismiss what you're feeling. “If we find something, then we can address it. If we don’t, then we’ll tell you we’re not sure exactly what’s causing your symptoms, but at least we can reassure you that you don’t have ovarian cancer,” explains Dabelea.
How ovarian cancer is diagnosed
When you visit your OBGYN, he or she will perform a pelvic exam. A pelvic exam involves feeling the structures inside of your abdomen, both from within your vagina using lubrication and gloved fingers, and by lightly pressing on your abdomen. A pelvic exam can help your doctor detect changes to the size or shape of your ovaries and uterus, which could indicate cancer.
“If I feel something on the pelvic exam, then I'll do an ultrasound. Usually we can do a trans-vaginal ultrasound right away in the office,” says Dabelea.
A trans-vaginal ultrasound involves inserting a sterile, lubricated wand, called a “transducer,” into the vagina by about two-to-three inches. The wand then uses sound waves to create images of your ovaries.
If your ultrasound reveals a mass or an area of concern, your doctor might send you for further testing. This could include:
- A CT scan: this test involves taking a series of x-ray images from many different angles. While it’s not as effective in detecting smaller tumors, it can spot larger tumors and see if they’ve grown to nearby areas.
- A blood test: blood levels of the CA-125 protein are often higher in women who have ovarian cancer. Since the level can increase when cancer grows and decreases when treatment starts working, it can be a useful tool for your doctor. However, since other conditions like endometriosis can make your CA-125 level go up too, it won’t be the only test that your doctor performs.
The only way to absolutely confirm an ovarian cancer diagnosis is to look at a tissue sample under a microscope, called a biopsy. This is typically done during surgery, when your surgeon removes an ovarian cyst or mass, which is then sent to a lab. If it’s cancer, your surgeon will remove all of it or as much as possible. Samples are also taken of various tissues to see if it has spread. Laparoscopic surgery is sometimes used. To perform the procedure your surgeon will make small cuts in your abdomen, and then insert a narrow tube with a camera on the end. The camera is used to get close-up views of your ovaries. Your surgeon can take tissue samples during laparoscopic surgery or even remove a mass. Another procedure for diagnosis would be inserting a needle through the abdomen, usually guided by ultrasound or a CT scan.
Communicate with your doctor
Make an appointment with your primary doctor or your OBGYN if you experience any symptoms of ovarian cancer. If your symptoms clear up after your doctor’s appointment, still attend your follow-up visits.
“I always tell my patients at least to call back,” says Dabelea. “Even if you’re not worried anymore, there may be something that’s concerning to me or a symptom that I’m watching.” Keep communication lines open with your doctor because ovarian cancer symptoms should be carefully monitored for changes over time.
