The signs of ovarian cancer are often quite vague—and that means it can go missed until it’s too late. Knowing the risk factors and symptoms can help with earlier detection.
Years ago, ovarian cancer was considered a “silent killer” because it wasn’t typically detected until the cancer had advanced. While today we know that symptoms are present at earlier stages, they are often vague and easily attributable to a host of other, less serious conditions.
“It’s the persistence of these subtle symptoms that should clue people in that something could be going on,” says Gizelka David-West, MD, a gynecologic oncologist with Northwell Health.
David-West explains that one of the challenges with ovarian cancer is that there are no tools for early detection screening in the general population, such as mammography for breast cancer or colonoscopy for colorectal cancer. Instead, screening is reserved for high-risk patients, such as women with hereditary breast and ovarian cancer syndrome (HBOC)—particularly the BRCA1 or BRCA2 genetic mutation. Women with a BRCA mutation have up to a 40% risk of ovarian cancer.
“For high-risk patients, we do a pelvic ultrasound every six months and a CA 125 blood test (to detect cancer antigens) every six months,” says David-West. While these tests are not ideal for screening early-stage cancer, it’s currently the recommended option for surveillance.
But it’s not practical to use ultrasound to screen all women. Most women have benign cysts that come and go over time. Unlike breasts, which are easy to biopsy, ovaries require surgery. David-West says doctors would do more harm than good by performing invasive exploratory procedures on women without high risk factors or a strong suspicion of disease.
Recognize the symptoms
Ovarian cancer does present symptoms and recognizing them increases a woman’s chance of finding the cancer before it has spread. As with other cancers, the earlier it’s detected and treated, the more favorable the outcome. Symptoms include:
- Bloating, gassiness, or tension/enlargement over the midsection
- Abdominal or pelvic pain
- Changes in urinary habits, such as frequency or pain
- Changes in bowel function
- Changes in appetite
Advocate for answers
Because it’s easy to misinterpret or brush off these symptoms, David-West advises women to note their duration. If symptoms persist for two weeks and treatments (like heartburn medicine, changing your diet, or taking an antibiotic for a possible urinary tract infection) aren’t helping, seek further evaluation.
“You may need imaging of the abdominal and pelvic cavities with a CT scan or pelvic ultrasound to see if something is going on with your ovaries,” she says.
David-West adds that when symptoms come up, patients will typically see their primary care doctor or a gastroenterologist. “A good general gynecologist might have a higher level of expertise in this area and will do some baseline imaging as a starting point,” she explains.
Know your risk factors
A big risk factor for ovarian cancer is family history. If your mother, grandmother, sister, or aunt had ovarian or breast cancer, speak to your doctor about genetic testing. Identifying a genetic mutation will prompt heightened screening as well as a more extensive workup if you experience any of those subtle symptoms.
Additional risk factors include:
- Age—the American Cancer Society reports that half of all ovarian cancers are found in women 63 or older
- Never having a full-term pregnancy, or having children after age 35
- Fertility treatments like in vitro fertilization (IVF)
- Being overweight or obese
- Use of hormone therapy after menopause
The encouraging news about ovarian cancer is that the mainstay of treatment—surgery and chemotherapy—have been enhanced in recent years using targeted drugs for maintenance therapy. Research has shown that matching the patient’s specific type of tumor to drugs that are known to be effective against it can lead to longer periods of remission.
“Even if the disease is found at an advanced stage, there are treatment options that allow patients to have prolonged remission, and if the disease recurs, we have a lot of treatments to give in that recurrent setting, allowing patients to live well with the cancer,” says David-West.
