What are the symptoms of ovarian cancer in a 56-year-old woman with a family history of the disease?

Ovarian Cancer Symptoms

Ovarian cancer presents with a recognizable cluster of abdominal and pelvic symptoms that are new-onset, persistent (occurring more than 12 days per month), and progressive—not a "silent disease" as commonly believed. 1

Cardinal Symptoms to Recognize

The following symptoms are independently associated with ovarian cancer and should trigger immediate evaluation, particularly in a 56-year-old woman with family history:

• Abdominal distension (persistent, not fluctuating) is the most significant symptom (OR 5.2), presenting as a hard, distended abdomen rather than intermittent bloating 2, 1
• Early satiety and difficulty eating independently predicts ovarian cancer (OR 5.0) 1, 2
• Pelvic or abdominal pain (vague or localized discomfort) occurs in the majority of patients 3, 1
• Urinary symptoms including frequency and urgency are consistently reported 1, 4

Additional Symptoms by Disease Stage

Early-stage disease may present with:

• Irregular menses in premenopausal women 3
• Postmenopausal bleeding (OR 9.2) 2
• Urinary frequency or constipation from mass effect on bladder/rectum 3
• Dyspareunia 3

Advanced-stage disease manifests with:

• Abdominal distension from ascites and masses 3, 1
• Nausea, anorexia, and loss of appetite (OR 3.2) 1, 2
• Constipation or bowel habit changes 3, 1
• Shortness of breath from pleural effusion (Stage IV) 3
• Palpable inguinal, supraclavicular, or axillary lymph nodes 3
• Weight loss, not weight gain, is characteristic of ovarian cancer due to metabolic depletion of adipose tissue and skeletal muscle 5

Critical Diagnostic Features

The temporal pattern matters more than individual symptoms:

• New-onset symptoms (not chronic or longstanding) 1
• Frequency >12 times per month 1
• Progressive worsening over weeks to months (OR 3.6) 2
• Symptom clusters rather than isolated complaints 4

Common Pitfalls to Avoid

• Do not dismiss "bloating" without clarification: Women use this term for two distinct presentations—persistent abdominal distension (associated with cancer) versus fluctuating distension/discomfort (not associated, OR 0.4) 2
• Do not rely on CA-125 alone: It is elevated in only ~50% of early-stage cases, though present in ~85% of advanced disease; normal CA-125 does not exclude ovarian cancer 1
• Do not attribute symptoms to benign conditions (endometriosis, irritable bowel syndrome, menopause) without imaging evaluation, as this is the primary reason for delayed diagnosis despite symptom presence 1, 6
• Do not confuse with breast cancer presentation: Weight gain occurs with breast cancer treatment, not ovarian cancer 5

Immediate Workup Algorithm

When the above symptom pattern is present in your patient:

1. Serum CA-125 measurement (recognizing its limitations in early disease) 1
2. Transvaginal and transabdominal ultrasound by an experienced examiner, ideally using IOTA Simple Rules or IOTA ADNEX model (superior to CA-125 alone) 1
3. CT chest/abdomen/pelvis with IV contrast if malignancy is suspected on ultrasound to determine staging 1, 7
4. Consider CEA and CA 19-9 if mucinous histology is suspected 1

Special Considerations for Your Patient

At age 56 with family history, your patient is at the typical age for diagnosis (average age 61) and has an established risk factor 3, 8. Given that 20% or more of ovarian cancers are hereditary, her family history significantly elevates concern 3. The average delay from symptom onset to diagnosis is 14 weeks, so prompt evaluation is essential 2, 4.