How to Recognize the Symptoms of Ovarian Cancer
September is Ovarian Cancer Awareness Month — can you detect the warning signs of this life-threatening disease? With tens of thousands of new diagnoses every year, ovarian cancer is a leading cause of death for American women, but spotting this disease early can greatly improve the odds of survival. Learn more about the causes of ovarian cancer, the symptoms, and how to spot it.
What Is Ovarian Cancer?
Ovaries are made of three types of cells that may develop into different types of tumors, according to the American Cancer Society. Epithelial tumors begin from cells covering the outer surface of the ovaries and account for most ovarian tumors; about 85-90% of malignant ovarian cancers are epithelial ovarian carcinomas. Ovarian cancers originating from epithelial tumors include:
- High-grade serous ovarian carcinoma (HGSOC)
- Low-grade serous ovarian carcinoma (LGSOC)
- Clear cell ovarian carcinoma
- Endometrioid ovarian carcinoma
- Mucinous carcinoma
- Borderline ovarian tumors
Germ cell tumors begin from the cells that produce eggs and are responsible for less than 2% of ovarian cancers. Germ cell tumors may include:
- Immature teratomas
- Dysgerminomas
- Yolk sac tumors
Stromal tumors — which begin from the structural tissue cells that hold the ovaries together and produce estrogen and progesterone — are even rarer, accounting for about 1% of ovarian cancers. Stromal tumors include:
- Granulosa cell tumors
- Sertoli-Leydig tumors
Ovarian cysts are another type of growth commonly found inside the ovaries. This collection of fluid most often occurs during the process of ovulation (functional cysts) and usually go away after a few months without treatment. Providers may want to examine after the next menstrual cycle.
The American Cancer Society estimates about 19,680 women will receive a new ovarian cancer diagnosis in 2024 and about 12,740 deaths will be attributed to the disease. The number of diagnoses has declined over the last few decades; the American Cancer Society reports the incidence rate has declined by about 1-2% per year from 1990 to the mid-2010s and almost 3% per year from 2015-2019. This is likely the result of increased use of oral contraceptives and less menopausal hormone therapy. Though ovarian cancer remains a leading cause of death in the United States, the rate of deaths has declined by 40% since 1975, likely because of better treatment options.
Signs & Symptoms
Though most women with ovarian cancer don’t experience symptoms until the cancer has spread, some women do experience symptoms in early stages. While some symptoms may be caused by other benign illnesses, women experiencing these symptoms more than 12 times a month should consult with their primary care providers. Some of the most common symptoms of ovarian cancer include:
- Bloating
- Pelvic or abdominal pain
- Trouble eating or feeling full quickly
- Urinary symptoms like urgency or frequency
Some other symptoms may include:
- Fatigue
- Upset stomach
- Back pain
- Pain during sex
- Constipation
- Changes in periods, such as heavier or irregular bleeding
- Abdominal swelling with weight loss
Early Detection
Unfortunately, only about 20% of ovarian cancers may be detected at an early stage. If detected early, however, about 94% of patients live longer than five years after diagnosis. While there are no recommended screenings for women who show no symptoms and aren’t at high risk, some common tests may detect abnormalities before they metastasize.
Routine gynecological exams may find some cancers early, but many ovarian cancers are difficult or impossible to detect through physical examination. If something is found, however, the doctor will recommend more tests, such as ultrasounds, CT scans, blood tests, or a biopsy.
A transvaginal ultrasound (TVUS) — which uses soundwaves to detect abnormalities in the uterus, fallopian tubes, and ovaries — may also detect tumors, but can’t provide any insight as to whether the mass is benign or malignant; most masses discovered with this screening method are not cancerous. A CA-125 blood test — which measures the amount of a protein called CA-125 in the blood — may also be used to detect ovarian cancer, but high CA-125 levels may also indicate other common, benign conditions such as endometriosis or pelvic inflammatory disease. Additionally, not every patient with ovarian cancer displays high CA-125 levels.
In any case, the only sure way to definitively diagnose an ovarian mass is cancerous is through a surgical biopsy, according to the Ovarian Cancer Research Alliance. Performed laparoscopically or robotically, physicians will collect a tissue sample from the affected ovary — sometimes using guidance from an ultrasound or CT scan — and send it to a lab for evaluation. Additionally, genetic testing can help women determine if they are above average risk due to an inherited genetic syndrome.