Symptoms of Ovarian Cancer
Ovarian cancer commonly presents with abdominal or pelvic pain, increased abdominal size/bloating, and difficulty eating/feeling full, especially when these symptoms occur more than 12 days per month and have been present for less than 1 year. 1
Common Symptoms
Ovarian cancer symptoms are often nonspecific, which can lead to delayed diagnosis. The most frequently reported symptoms include:
Early and Advanced Disease
- Abdominal or pelvic pain (present in 52% of cases) 2
- Abdominal distension, bloating, and increased abdominal girth (present in 37% of cases) 2
- Gastrointestinal problems including constipation, diarrhea, nausea, and early satiety (present in 36% of cases) 2
- Urinary frequency or urgency 3, 1
- Fatigue 3
Advanced Disease Additional Symptoms
- Ascites leading to increased abdominal girth 3
- Nausea and anorexia 3
- Dyspepsia and early satiety 3
- Respiratory symptoms due to pleural effusions 3
- Palpable abdominal or nodal masses (inguinal, axillary, or supraclavicular) 3
Symptom Index for Earlier Detection
A symptom index has been developed that may help identify women at risk for ovarian cancer. This index is considered positive when any of these symptoms are present:
- Pelvic/abdominal pain
- Increased abdominal size/bloating
- Difficulty eating/feeling full
The key distinguishing factors are:
- Symptoms occur >12 times per month
- Symptoms have been present for <1 year
This index has shown:
- 56.7% sensitivity for early-stage disease
- 79.5% sensitivity for advanced-stage disease
- 90% specificity in women >50 years
- 86.7% specificity in women <50 years 1
Important Clinical Considerations
Symptom Recognition Challenges
- Symptoms are often vague and nonspecific, leading to delayed diagnosis 4
- 95% of women with ovarian cancer report at least one symptom up to 2 years before diagnosis, compared to only 28% of women without ovarian cancer 2
- Early-stage ovarian cancer (confined to the ovary) may cause few or no symptoms, making early clinical diagnosis difficult 3
Risk Factors and Screening
- Ovarian cancer is more common in women older than 50 years 5
- Routine screening is not recommended for the general population 3, 6
- Women with a family history of ovarian cancer or known genetic syndromes should be offered genetic counseling 5
Diagnostic Approach
- Initial diagnostic tests include transvaginal ultrasonography (sensitivity 85-90%) and serum CA-125 measurement (elevated in 85% of advanced cases but only 50% of early-stage cases) 3, 6
- CT of abdomen and pelvis with contrast is recommended for initial imaging 6
- Additional markers may be considered based on suspected histology (CEA, CA 19-9, hCG, AFP, LDH, Inhibin) 6
When to Suspect Ovarian Cancer
Be particularly vigilant when:
- Multiple gastrointestinal, urinary, gynecologic, or constitutional symptoms occur together
- Symptoms persist or worsen despite appropriate treatment
- Symptoms are new onset in women over 50 years
- There is a family history of ovarian or breast cancer
- Symptoms follow the pattern of the symptom index (>12 times monthly, <1 year duration)
Pitfalls to Avoid
- Attributing symptoms to common benign conditions without considering ovarian cancer
- Delaying referral for imaging when persistent symptoms are present
- Relying solely on CA-125 for early detection (only elevated in about 50% of stage I disease) 3
- Failing to recognize that symptoms may be present up to 2 years before diagnosis 2
- Missing the opportunity to identify women at increased genetic risk during preventive visits 5