What are the signs and symptoms of ovarian cancer?

Signs and Symptoms of Ovarian Cancer

The key signs and symptoms of ovarian cancer include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms (urgency or frequency), especially when these symptoms are new and occur frequently (>12 days per month). 1

Common Presenting Symptoms

Primary Symptoms

• Abdominal/pelvic pain - One of the most common presenting symptoms 1, 2
• Increased abdominal size/bloating - Often persistent and progressive 1
• Difficulty eating/feeling full quickly (early satiety) 1, 2
• Urinary symptoms (urgency or frequency) 1

Additional Symptoms in Advanced Disease

• Abdominal distension due to ascites 1, 2
• Nausea and anorexia 2
• Constipation or changes in bowel habits 1, 2
• Fatigue 2
• Shortness of breath (if pleural effusions are present) 1, 2
• Palpable enlarged lymph nodes (inguinal, supraclavicular, axillary) in cases with nodal metastases 1

Clinical Significance of Symptoms

Symptom Pattern Recognition

• Symptoms are most concerning when they are:
  • New onset (present for <1 year) 3
  • Frequent (occurring >12 days per month) 1, 3
  • Persistent rather than intermittent 4
  • Multiple symptoms occurring together 5

Warning Signs

• The presence of multiple symptoms significantly increases the likelihood of ovarian cancer 3, 5
• Each additional presenting symptom is associated with decreased survival (HR 1.20,95% CI 1.12-1.28) 5
• Abdominal pain and loss of appetite/feeling full are independently associated with increased mortality 5

Diagnostic Considerations

Symptom Recognition Challenges

• Symptoms are often vague and can be attributed to other conditions 1
• There is typically a short interval between symptom onset and diagnosis, limiting the window for early detection 6
• Symptoms may be more pronounced in advanced disease than early-stage disease 3

High-Risk Groups

• Women with BRCA1/BRCA2 mutations or Lynch syndrome should be particularly vigilant about these symptoms 1
• Postmenopausal women with these symptoms have a poorer prognosis 5

Common Pitfalls in Symptom Recognition

1. Dismissing symptoms as normal aging or digestive issues - The subtle nature of symptoms often leads to delayed diagnosis 4

2. Failure to recognize symptom patterns - Individual symptoms may seem benign, but their combination and persistence are significant 3

3. Overlooking symptoms in younger women - While ovarian cancer is more common in older women, symptoms should not be dismissed in younger patients 2

4. Attributing symptoms to other conditions - Symptoms may be misdiagnosed as irritable bowel syndrome, stress, or menopause 4

5. Waiting for CA-125 elevation - CA-125 is elevated in only ~50% of early-stage cases, so normal levels should not rule out ovarian cancer if symptoms are present 2

When these characteristic symptoms are present, especially in combination and with recent onset and high frequency, healthcare providers should include ovarian cancer in their differential diagnosis and proceed with appropriate diagnostic workup including pelvic examination, transvaginal ultrasound, and serum CA-125 testing 1, 2.