What are the symptoms of ovarian cancer?

Symptoms of Ovarian Cancer

The key 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

Primary Symptoms and Their Characteristics

The most significant symptoms of ovarian cancer include:

• Bloating/increased abdominal size
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary urgency or frequency

These symptoms are particularly concerning when they have the following characteristics:

• New onset (present for less than 1 year)
• Frequent (occurring more than 12 days per month)
• Persistent rather than intermittent 1, 2

Symptoms typically become more pronounced in the 3 months before diagnosis, with higher prevalence in advanced-stage disease compared to early-stage disease 1.

Symptom Index for Identifying Women at Risk

Research has established a symptom index that may help identify women at higher risk for ovarian cancer. This index is considered positive when any of these symptoms occur:

• Pelvic/abdominal pain
• Increased abdominal size/bloating
• Difficulty eating/feeling full

The index is most concerning when these symptoms are present for less than 1 year and occur more than 12 times per month 2.

The sensitivity of this symptom index is:

• 56.7% for early-stage disease
• 79.5% for advanced-stage disease

The specificity is:

• 90% for women over 50 years
• 86.7% for women under 50 years 2

Timing of Symptom Presentation

It's important to note that symptoms often appear close to the time of diagnosis, which can limit their usefulness for early detection 3. Studies show that both early and late-stage patients have a higher prevalence of abdominal/pelvic pain and bloating than comparison groups, primarily in the 3 months before diagnosis 3.

Clinical Pitfalls to Avoid

1. Dismissing symptoms as common female complaints: The symptoms of ovarian cancer are non-specific and often attributed to benign conditions, leading to diagnostic delays 4. Always consider ovarian cancer in the differential diagnosis when these symptoms persist.

2. Failing to recognize symptom patterns: When multiple symptoms occur together, especially with the characteristics mentioned above (new onset, frequent, persistent), the index of suspicion should be raised 5.

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

4. Relying solely on CA-125: This biomarker is not specific to ovarian cancer and may be elevated in non-gynecological malignancies and benign conditions 1.

Diagnostic Approach When Symptoms Are Present

When a patient presents with concerning symptoms:

1. Evaluate the frequency, duration, and severity of symptoms
2. Consider transvaginal and transabdominal ultrasound as the initial imaging of choice (sensitivity 85-90% for detecting ovarian masses) 1
3. Measure appropriate biomarkers:
   • CA-125 (sensitivity 85-90% for ovarian cancer)
   • Other markers for specific tumor types (CEA, CA 19-9, hCG, AFP, LDH, Inhibin) 1
4. If findings are concerning, proceed with CT scan of thorax, abdomen, and pelvis for staging and surgical planning 1

Remember that epithelial ovarian cancer classically presents with vague persistent gastrointestinal, urologic, or non-acute abdominal/pelvic symptoms including bloating, early satiety, and discomfort 6. Until an effective screening test becomes available, awareness of these symptoms and prompt evaluation are critical for timely diagnosis.