Don’t Ignore These Ovarian Cancer Warnings Signs

Ovarian cancer can be a challenging condition to diagnose, as it often doesn't create noticeable symptoms in its early stages. However, understanding the risk factors and potential signs of the disease can help you better recognize when something is off, and it's time to see your doctor. Kevin Kremer, MD, explains the signs to look for, prevention and treatment.

Early Signs of Ovarian Cancer

The first symptoms of ovarian cancer are typically non-existent. If it’s found in an early stage, it’s likely because a patient had imaging done for an unrelated issue — and the radiologist happened to catch it.

“Nearly 75% of ovarian cancers are diagnosed at Stage III or IV, and that’s usually when symptoms start happening,” Dr. Kremer says.

Symptoms of Ovarian Cancer

Symptoms of late-stage ovarian cancer include:

• Back pain
  
• Bloating
• Constipation
• Fatigue
• Frequent urination
• Getting full easily
• Loss of appetite
• Nausea
• Pain during intercourse
• Rapid weight loss
• Rapid weight gain
• Vomiting

Postmenopausal women should generally be aware of any abnormal symptoms in the pelvic area.

“It’s a good idea to get evaluated to make sure nothing is missed,” Dr. Kremer says.

Unusual Symptoms of Ovarian Cancer

Ovarian cancer can present with symptoms that don’t seem as obvious. For instance, indigestion issues, such a heartburn, can be a sign of ovarian cancer. This happens because, in its later stages, ovarian cancer can spread and impact nerves that control digestion — triggering other issues such as nausea, vomiting or loss of appetite.

Urinary frequency and urgency are also unexpected symptoms of ovarian cancer.

The cause can be due to a growing tumor putting pressure on the bladder and ureters. It can make you feel like you need to urinate more often, even if there's only a small amount of urine.

It's important to note these symptoms are more likely caused by other conditions. If you have any of these symptoms for more than a few weeks, see your doctor for an evaluation.

Ovarian Cancer Risk Factors

The average age of an ovarian cancer diagnosis is 63. It’s uncommon in women under the age of 40. There’s about a 1- 2% lifetime risk of ovarian cancer in women without high-risk factors.

The primary risk factor in ovarian cancer is a genetic mutation.

“A BRCA mutation, or a mutation associated with Lynch syndrome, can increase your risk. There are some other mutations more common with breast cancer, but they’re associated with ovarian cancer, too,” Dr. Kremer says.

There’s also increased risk for people who’ve never had children and those who’ve never taken birth control.

How to Prevent Ovarian Cancer

“Having children and taking birth control, those are things that protect against ovarian cancer. Taking a hormonal birth control — like combined contraceptive pills — for at least five consecutive years at some point in your lifetime decreases your risk of getting ovarian cancer, too,” Dr. Kremer says.

However, the risk reduction is small in these instances.

If you’re concerned about your risk for ovarian cancer, consider genetic testing and counseling. You’ll be asked questions about your medical and family history, and your counselor will review results with you in detail.

Check with your insurance company to see if it covers the cost of genetic testing for ovarian and other cancers. If not, it’s about $250 out-of-pocket.

Dr. Kremer says the best way to stay on top of your health is to follow up with a primary care provider regularly.

“If you’re having some symptoms and aren’t sure what to make of them, tell your doctor. They’ll do a further work-up to make sure you’re OK,” he says.

Do Ovarian Cancer Symptoms Come and Go?

Dr. Kremer says it’s unlikely for ovarian symptoms to go away and then come back.

“You might feel a little better on some days, but you probably won’t go back to feeling normal.”

Do Ovarian Cancer Symptoms Start Suddenly?

At times, pain starts suddenly, but it’s more common in later stages of the disease.

Ovarian cancer symptoms often start gradually. Initial signs may include some digestive distress, such as nausea and bloating. You may start to feel full easily, too. They may not feel as significant in the beginning and start to get worse over time. These are also symptoms of many other non-cancer-related conditions and may be completely harmless.

Weight loss, along with digestive distress, is a red flag. Sudden weight gain can be another sign something is wrong.

If you’ve gained 10 pounds in one or two weeks, that’s concerning. If you can noticeably see your belly getting bigger over a short time frame, there may be fluid buildup in the abdomen (called ascites) due to the cancer,” Dr. Kremer says.

Do Ovarian Cancer Symptoms Get Worse with Menstruation?

Since ovarian cancer is extremely uncommon in premenopausal women, it’s not clear if symptoms get worse during periods.

“Endometriosis, which is worse during menstrual cycles, can be associated with certain types of ovarian cancer. But it's still very rare in a premenopausal woman,” Dr. Kremer says.

How to Test for Ovarian Cancer

There isn’t a perfect screening for ovarian cancer. There are blood tests that check tumor marker levels (such as CA-125, CA-19-9), and they’re used to help diagnose ovarian cancer.

However, these tumor markers can be elevated due to other conditions. They’re only used in combination with other diagnostic tests, such as imaging studies and physical exams.

Dr. Kremer says, “There are blood tests we might use for people who come in and have a noticeable mass, and there’s a concern for ovarian cancer. Studies show when they're used as a screening method, the patient ends up having more ultrasounds or surgery, without any improvement in detection rates, so checking these blood tests routinely for women is not recommended.”

Ultrasounds, along with CT scans, are commonly used to detect ovarian cancer in symptomatic patients.

How to Check for Ovarian Cancer at Home

There’s an at-home test on the market that checks for the tumor marker CA-125, but Dr. Kremer doesn’t recommend it. It’s not a reliable test and, as mentioned, tumor markers can be elevated for a variety of reasons and don’t necessarily indicate cancer. Early detection of ovarian cancer often requires professional medical evaluation and specific diagnostic tests.

Ovarian Cancer Treatment

Ovarian cancer treatment typically involves a combination of surgery and chemotherapy. The specific approach depends on the stage of the cancer, your overall health and personal preferences.

• Surgery: The goal of surgery is to remove as much of the cancer as possible. This may involve removing the ovaries, fallopian tubes, uterus and other affected tissues. In some cases, additional procedures are necessary, such as removing lymph nodes or parts of the peritoneum (a thin membrane that covers your organs).
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It can be administered through intravenous infusion or orally. Chemotherapy is often used both before and after surgery to treat remaining cancer cells.

In some cases, radiation therapy may be used to treat ovarian cancer. This involves using high-energy rays to kill cancer cells.

The goal of treatment for ovarian cancer is to achieve complete remission, which means the cancer isn’t detectable. After treatment, regular follow-ups are important to monitor for recurrence of the cancer.

Discuss treatment options with your doctor to develop a plan that’s best for you. The decision-making process can be complex, and it's essential to know the risks, benefits and potential side effects of each treatment option.