What are the symptoms of ovarian cancer?

Symptoms of Ovarian Cancer

The most common 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, 2

Key Symptom Patterns

Primary Symptoms

• Abdominal/Pelvic Symptoms:

  • Bloating/increased abdominal size 2, 3
  • Pelvic or abdominal pain 2, 3
  • Difficulty eating or feeling full quickly (early satiety) 2, 3

• Urinary Symptoms:

  • Urinary urgency 2
  • Urinary frequency 2

Additional Symptoms

• Fatigue 2
• In advanced disease: ascites and respiratory symptoms 2
• Back pain 4
• Systemic symptoms (such as unexplained weight loss) 4

Clinical Significance

The NCCN Guidelines emphasize that these symptoms are particularly concerning when they are:

1. New onset (not longstanding)
2. Frequent (occurring >12 days per month)
3. Persistent rather than intermittent 1, 3

Research has shown that symptoms typically become more pronounced in the 3 months before diagnosis, with advanced-stage disease showing higher symptom prevalence than early-stage disease 4, 5.

Diagnostic Considerations

When evaluating women with these symptoms, physicians should consider the possibility of ovarian pathology 1. Studies have demonstrated that:

• Symptom patterns have a sensitivity of 56.7% for early-stage disease and 79.5% for advanced-stage disease 3
• Specificity is approximately 90% for women over 50 years and 86.7% for women under 50 years 3

Important Caveats

1. Symptom Overlap: These symptoms are common and can be caused by many benign conditions, making early diagnosis challenging 6

2. Timing Challenge: Symptoms may occur too close to diagnosis to provide sufficient lead time for early intervention 5

3. Screening Limitations: Despite symptom recognition, randomized data do not yet support routine screening for ovarian cancer in the general population 1

4. Symptom Index: A symptom index considering the presence of pelvic/abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full when present for <1 year and occurring >12 days per month may help identify women at higher risk 3

5. Clinical Judgment: Timely diagnosis ultimately relies on clinical judgment and careful analysis of presenting symptoms within the context of a thoughtful dialogue between patient and physician 6

While most women with these symptoms do not have ovarian cancer, healthcare providers should include ovarian cancer in their differential diagnosis when these symptoms are present, especially in their characteristic pattern of recent onset and high frequency 6.