What to know about the symptoms of ovarian cancer

Ovarian cancer affects the ovaries, two small organs in the pelvis that store and release eggs during the menstrual cycle. Since the signs can be difficult to recognize, it's often diagnosed after it's already reached a late stage and has spread to other organs.

Early symptoms of ovarian cancer can be vague or mimic those of other common conditions, including premenstrual syndrome (PMS), which can cause bloating, swelling, fatigue, and mood changes. The overlap in symptoms between ovarian cancer and other conditions can make it easier to overlook and delay getting checked by a healthcare provider (HCP).

Here are symptoms of ovarian cancer symptoms everyone should know about, and when to call your HCP.

Symptoms 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, an OBGYN in Denver. “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 typical symptom is feeling bloated. You may have difficulty eating or feel full too quickly. You may also feel that the size of your abdomen is increasing, even though you’re eating less or possibly even 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), making you feel like you need to urinate frequently or urgently. Some people also experience vaginal bleeding that’s not typical for their menstrual cycle, or that occurs after menopause (not having a menstrual cycle for 12 months in a row).

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 HCP, especially if you experience them more than 12 times a month. Also tell your HCP if you feel bloated nearly every day for three weeks or more.

When to see your HCP

“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 HCP, they 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 HCP 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 transvaginal ultrasound right away in the office,” says Dabelea. A transvaginal ultrasound involves inserting a sterile, lubricated wand called a transducer about 2 or 3 inches into the vagina. The wand then uses sound waves to create images of your ovaries.

If your ultrasound reveals a mass or an area of concern, your HCP 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 (solid mass of cancer cells), it can spot larger tumors and see if they’ve grown to nearby areas.
• A blood test: Blood levels of the cancer antigen-125 (CA-125) protein are often higher in people who have ovarian cancer. Since the levels can increase when cancer grows and decrease when treatment starts working, the test can be a useful tool for your HCP. However, since other conditions like endometriosis can increase your CA-125 level, it won’t be the only test that your HCP performs. Endometriosis is when cells from the inner lining of the uterus grow outside the uterus, causing pain and symptoms similar to ovarian cancer.

The only way to confirm an ovarian cancer diagnosis is to look at a tissue sample, called a biopsy, under a microscope. This is typically done during surgery, when a surgeon removes a piece of ovarian tissue and sends it to a laboratory for analysis. If it’s cancer, your surgeon will remove all of the cancer as possible.

Samples are also taken of various tissues near the ovaries to see if the cancer has spread. Laparoscopic (minimally invasive) surgery is sometimes used to help speed recovery. 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 an irregular growth.

Another procedure for diagnosis would be inserting a needle through the abdomen, usually guided by ultrasound or a CT scan.

Communicate with your HCP

Make an appointment with your primary doctor or your OBGYN if you experience any symptoms of ovarian cancer. If your symptoms clear up after the appointment with your HCP, make sure to go to follow-up appointments.

“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.”

It's important to keep communication lines open with your HCP because ovarian cancer symptoms should be carefully monitored for changes over time.