What are the symptoms of ovarian cancer?

Ovarian Cancer Symptoms

The most frequent symptoms of ovarian cancer are abdominal discomfort or vague pain, abdominal fullness, bowel habit changes, early satiety, dyspepsia, and bloating, with symptoms being particularly concerning when they are new, occur frequently (>12 days per month), and persist for less than one year. 1, 2

Most Common Presenting Symptoms

The cardinal symptoms that should raise suspicion for ovarian cancer include:

• Abdominal discomfort or vague pain - This is one of the most frequent presenting symptoms and represents a significant independent predictor of malignancy 1
• Increased abdominal size/bloating - Women with ovarian cancer have 7.4 times higher odds of experiencing increased abdominal size compared to women in primary care settings, and this symptom independently predicts cancer 3, 4
• Early satiety or difficulty eating/feeling full quickly - This gastrointestinal symptom independently predicts ovarian cancer and is associated with increased mortality in multivariable analysis 1, 3, 5
• Urinary symptoms - Including urgency and frequency, with women having 2.5 times higher odds of urinary urgency compared to controls 2, 4

Critical Pattern Recognition for Clinicians

The combination of bloating, increased abdominal size, and urinary symptoms occurs in 43% of women with ovarian cancer but only 8% of women presenting to primary care clinics. 4 This specific symptom cluster should prompt immediate investigation.

Frequency and Duration Thresholds

The National Comprehensive Cancer Network emphasizes that symptoms are particularly concerning when they meet specific criteria 2:

• Frequency: Occurring more than 12 days per month 2, 3
• Duration: Present for less than 1 year (indicating recent onset) 3
• Pattern: New symptoms that persist rather than completely resolve 2

Women with malignant masses typically experience symptoms 20-30 times per month with significantly higher severity compared to those with benign masses 4

Stage-Specific Symptom Presentations

Early Stage Disease

In early-stage ovarian cancer, patients may present with 1:

• Irregular menses (if premenopausal) 1
• Urinary frequency and/or constipation due to pelvic mass compression of bladder or rectum 1
• Lower abdominal distention, pressure, or pain including dyspareunia 1
• Acute pain from rupture or torsion (though unusual) 1

Advanced Stage Disease

Advanced-stage patients most often have symptoms related to ascites and abdominal masses 1:

• Abdominal distention and bloating from ascites 1
• Constipation, nausea, anorexia 1
• Shortness of breath from pleural effusion (Stage IV disease) 1
• Palpable enlarged lymph nodes (inguinal, supraclavicular, or axillary) if nodal metastases present 1
• Bowel obstruction from intra-abdominal masses 1

Diagnostic Performance of Symptom Indices

A validated symptom index considering pelvic/abdominal pain, increased abdominal size/bloating, and difficulty eating/feeling full as positive when occurring >12 times per month but present for <1 year demonstrated 3:

• Sensitivity: 56.7% for early-stage disease and 79.5% for advanced-stage disease 3
• Specificity: 90% for women >50 years and 86.7% for women <50 years 3

Important Clinical Caveats

Common Pitfalls to Avoid

• Do not attribute persistent symptoms to irritable bowel syndrome without excluding ovarian pathology, particularly when symptoms meet the frequency and duration criteria outlined above 2
• Recognize that symptoms often occur close to diagnosis - most symptoms become prevalent primarily in the 3 months before diagnosis, which limits their utility for truly early detection 6, 7
• Understand that positive predictive values are generally quite low because these symptoms are common in the general population, with 72% of women in primary care reporting recurring symptoms 4, 7

Prognostic Implications

Women presenting with symptoms listed in symptom indices have significantly worse survival (HR 1.68,95% CI 1.32-2.13) compared to those without these symptoms 5. Each additional presenting symptom decreases survival (HR 1.20,95% CI 1.12-1.28) 5. Specifically, abdominal pain and loss of appetite/feeling full are independently associated with increased mortality in multivariable analysis 5.

When Immediate Evaluation is Warranted

Urgent investigation should be pursued when 2:

• Rapid increase in abdominal size over days to weeks 2
• Shortness of breath from significant abdominal distension 2
• Any persistent combination of symptoms occurring >12 days per month 2
• Palpable pelvic mass on clinical examination 1