I have new abdominal bloating and appear pregnant; can I still develop ovarian cancer despite a normal transvaginal ultrasound performed one year ago?

Yes, You Can Still Develop Ovarian Cancer Despite a Normal Ultrasound One Year Ago

A normal transvaginal ultrasound from one year ago does not exclude the possibility of ovarian cancer now, especially given your new symptoms of bloating and abdominal distension that make you appear pregnant. 1, 2

Why Your Symptoms Warrant Immediate Evaluation

Your specific symptom pattern—new bloating with abdominal distension making you look pregnant—is a primary presenting symptom of ovarian cancer that requires urgent workup regardless of prior imaging. 1, 3, 2

• Bloating and abdominal distension are recognized cardinal symptoms of ovarian cancer, particularly when they represent a new change and occur frequently (>12 days per month). 1, 3
• In advanced ovarian cancer, ascites and abdominal masses specifically cause increased abdominal girth, bloating, nausea, anorexia, and early satiety—matching your description of looking pregnant. 1
• Approximately 95% of ovarian cancer patients experience these nonspecific symptoms at diagnosis, yet about 80% already have advanced-stage disease (stage III-IV) by the time symptoms appear. 2

The Critical Timing Issue

Ovarian cancer can develop and progress to advanced stages within a 12-month window, making your year-old ultrasound essentially irrelevant to your current symptoms. 2, 4

• High-grade serous ovarian carcinoma (70% of ovarian cancers) is characterized by rapid growth and early metastatic spread. 1, 2
• Most ovarian cancers are diagnosed at advanced stages specifically because early disease produces few or no symptoms, while your symptoms suggest more advanced disease that would not have been present a year ago. 1, 2, 4

Required Immediate Workup

You need a comprehensive evaluation now that includes:

Essential Imaging

• New transvaginal AND transabdominal ultrasound performed by an expert examiner to characterize any ovarian masses, assess for ascites, and evaluate for solid papillary projections or irregular internal septations. 1, 5
• CT scan of chest, abdomen, and pelvis to complete clinical staging and identify any extrapelvic disease or abdominal masses. 1, 2

Laboratory Testing

• Serum CA-125 measurement, which is elevated in approximately 85% of advanced ovarian cancer cases (though only 50% of early-stage cases). 1
• Consider CEA and CA 19-9 if mucinous histology or gastrointestinal origin needs to be distinguished. 1

Red Flags in Your Presentation

Several concerning features make your situation particularly urgent:

• Rapid increase in abdominal size (appearing pregnant) over a short timeframe suggests significant fluid accumulation (ascites) or mass effect. 5, 3
• New onset of symptoms is more concerning than chronic symptoms, especially when persistent rather than intermittent. 3
• The specific combination of bloating with visible abdominal distension represents a high-risk symptom pattern that should never be dismissed. 1, 3, 2

Common Pitfall to Avoid

Do not allow your prior normal ultrasound to provide false reassurance. 3 The most dangerous error would be attributing your persistent symptoms to benign conditions like irritable bowel syndrome or weight gain without excluding ovarian pathology through current imaging and tumor markers. 3

Immediate Next Steps

1. Contact your gynecologist or primary care physician within 24-48 hours to report these new symptoms and request urgent evaluation. 1, 6
2. Request specific testing: transvaginal ultrasound, CA-125, and abdominal/pelvic CT if initial ultrasound shows concerning features. 1, 5
3. Demand referral to gynecologic oncology if ultrasound shows any suspicious features (O-RADS 4-5), ascites, or if CA-125 is elevated. 5, 6

Additional Context on Screening Limitations

Routine screening for ovarian cancer with transvaginal ultrasound and CA-125 is not recommended for average-risk women precisely because these tests lack sufficient sensitivity for early detection and have poor positive predictive value (approximately 2%). 1, 7 However, your situation is fundamentally different—you have symptoms, which completely changes the diagnostic approach from screening to diagnostic evaluation. 1, 6