What are the symptoms of ovarian cancer?

Ovarian cancer is the sixth most common cause of female cancer death in Australia. Ovarian cancer symptoms can be easily dismissed but it is important to take them seriously because the earlier ovarian cancer is found, the easier it is to treat. Cervical screening tests for cervical cancer, not ovarian cancer. Everyone needs to know the symptoms to watch out for.

Common symptoms include:

• Abdominal/pelvic pain or discomfort
• Increased abdominal size/bloating
• Bowel habit changes
• Eating less and feeling fuller
• Needing to urinate more often or urgently
• Fatigue

But any of the following could be a symptom of ovarian cancer:

• Feeling full after eating only a few bites or loss of appetite
• Diarrhoea, constipation, bowel or rectum feels full, change in bowel habits, constant urge to have a bowel movement, painful or burning bowel movements, rectal pain, painful defecation
• Bloating, distension of abdomen, clothes around the waist feel too tight, feel an abdominal mass
• Weight loss not because of dieting
• Nausea, vomiting, heartburn, gas, burping, indigestion
• Increased urinary frequency, need to urinate urgently, pressure on the bladder, leaking urine, burning sensation when urinating, need to urinate but unable to do so, unable to empty bladder completely, feeling full after urinating
• Vaginal discharge, bleeding, spotting, deep pain on intercourse
• Discomfort or pain in abdomen, pelvic region, or lower back

Cervical screening does not detect ovarian cancer

When should I see my doctor?

Take note of any changes which are NEW, UNUSUAL or GETTING WORSE. If any symptom is still happening after TWO WEEKS then you should get it checked out. Ovarian cancer is more treatable when it is found early.

Know your normal

Even one symptom is enough to tell your doctor about.

What to expect at the doctors?

Medical History

A typical doctor's appointment will start with a thorough history. Your doctor will ask you questions about your symptoms including the duration (when they started), frequency (how often they happen) and severity (how much they are affecting you). Some people find it helpful to keep a symptoms diary.

It's important to tell your doctor if you have a family history of cancer - especially ovarian, breast and bowel cancer.

Common conditions ovarian cancer can be mistaken for

Doctors can sometimes mistake the symptoms of ovarian cancer for irritable bowel syndrome (most common) or constipation, urinary tract infections, depression, gastritis, stress, menopause or just needing to lose some weight.

Getting a second (or third or forth) opinion

About one in 10 women with ovarian cancer in Australia see their doctor for three or more months before they are diagnosed. Younger women, like many of those with low-grade serous ovarian cancer, are more likely to experience difficulties getting a diagnosis. If you feel your concerns are not being taken seriously, please seek a another opinion. Especially if someone tells you, you are too young for cancer - sadly there is no such thing as too young.

It's your right to see someone else. Always let your doctor know if your symptoms are getting worse.

Cure Our Ovarian Cancer believes that doctors should when in doubt, rule the ovaries out.

Pelvic exam

© 2009 Terese Winslow, U.S. Govt. has certain rights.

The doctor should ask to perform a pelvic exam. Most people with ovarian cancer have a normal pelvic exam - but sometimes a doctor can feel a lump or other change.

Before the doctor starts performing the pelvic exam they will explain the procedure and get your consent. It's your choice whether you want to proceed with the examination. You can ask for a support person to be present during the procedure. This could be someone you bring with you, or a nurse or staff member at the practice.

During the pelvic exam the doctor will insert two lubricated and gloved fingers inside the vagina and use their other hand to gently press down on the area they are feeling. It might feel a little uncomfortable but it should not be painful.

An abnormal finding does not necessarily mean that you have ovarian cancer - but your doctor will order testing to investigate further.

If the pelvic exam is normal your doctor may order testing, or refer you to a specialist for further review.

Always tell your doctor if your symptoms are getting worse.

Blood test

Another test for ovarian cancer is the CA-125 blood test. This test looks for a specific protein in the blood which can be elevated with ovarian cancer. If you are still menstruating and your period is due soon, the doctor may ask for you to wait until after your period as it can affect the results.

Ovarian cancer is more likely if the result is at least 35 units/mL. However, most people with an elevated CA-125 do not have ovarian cancer, and some people with ovarian cancer can have a normal blood test. This is more common in young people and early cancer.

A normal CA-125 blood test result does not exclude ovarian cancer. If you continue to have symptoms it is important to tell your doctor.

Ultrasound

Your doctor or a specialist will likely also make a referral for a pelvic and trans-vaginal ultrasound. This is a safe and painless test which uses sound waves to create images of structures inside your body like the ovaries.

Before the scan you might be instructed to drink water an hour before your appointment so your bladder is full.

During the pelvic ultrasound - the sensor will be placed on the abdomen with a lubricating gel.

In order to get a better view of the ovaries a trans-vaginal ultrasound will also be performed. During the trans-vaginal ultrasound a long, thin probe (called a transducer) which is covered in a plastic/latex shield and lubricating gel is inserted into the vagina. The transducer is larger than a tampon but smaller than a typical speculum used during cervical screening. You can ask to insert it yourself. During the exam the transducer will be gently turned and angled to look at different areas. You might feel mild pressure.

Usually an ultrasound is no big deal. But if you have difficulty with vaginal insertions (e.g. vaginismus) or have been a victim of sexual abuse, are trans or non-binary or are just feeling a bit nervous - please have a chat to your doctor before the scan. They can prescribe a medication to help you feel more relaxed, and request a longer appointment time. Let the sonographer know how you are feeling too. They are trained professionals and will usually go out of their way to make you feel comfortable.

Computed Tomography (CT)

Sometimes other imaging like a CT is used instead of, or as well as an ultrasound. A CT is a type of 3-dimensional x-ray which can image bones, organs, tissues and tumours. CT scans are more detailed than ultrasounds - but the additional detail is not always necessary. Unlike an ultrasound, a CT scan also carries a small risk of complications from radiation. Allergic reactions to the contrast dye are also possible but not common. To minimise risks a CT scan will only be ordered if necessary.

Results

Depending on the results you may be monitored, referred to a specialist, or scheduled for repeat testing.

If both the CA-125 blood test and trans-vaginal ultrasound are normal - your doctor will investigate other causes. There is research to suggest that sometimes both tests can be normal if the cancer is early and diffuse (spread thinly instead of growing in a lump). Because of this, your doctor may decide to recheck the CA-125 blood test 4 to 12 weeks later if you continue to have symptoms.

It is very important to let your doctor know if your symptom(s) get worse.

Are there any risks that make ovarian cancer more likely?

Typically, about one in seventy women will develop ovarian cancer in their lifetime. But certain things can increase or reduce the risk of ovarian cancer.

Family History

The most significant individual risk factor for people born with ovaries, is a family history of cancer. The BRCA 1/2 mutations and HNPCC (Lynch Syndrome) are associated with an 8% to 44% lifetime risk of ovarian cancer. They can be inherited from either parent. People with a family history of ovarian, breast, pancreatic or colorectal cancer should discuss whether genetic testing is appropriate with their doctor. Hereditary ovarian cancer may be preventable.

However 9 out of 10 people with ovarian cancer have NO family history.

Surgery

It is becoming more common for people past the age of child bearing who require a gynaecological surgery for another reason to have their fallopian tubes removed at the same time (also known as opportunistic salpingectomy). Because most ovarian cancer starts in the fallopian tube, this can significantly reduce (but not eliminate) the chance of developing ovarian cancer.

• Oral contraceptive use
• Healthy weight
• Giving birth

The most important risk for ovarian cancer is symptoms - if you experience any symptoms and they are new, unusual or worsening, and last for two or more weeks please get checked.

Is all ovarian cancer the same?

Ovarian cancer is the name given to cancer affecting the fallopian tube, peritoneum (lining of the abdomen) and ovaries. It is an umbrella term that encompasses many different types of ovarian cancer that can affect the epithelium (surface cells), stromal (connective tissue) or germ cell (reproductive cells).

There are many different types - including borderline (which is actually precancerous), high-grade serous (the most common), low-grade serous (disproportionately younger women), clear cell, endometrioid, mucinous and germ cell ovarian cancer. Each type of ovarian cancer is a cancer in its own right - and behaves differently and responds differently to treatment.

Share the symptoms

Not many people know the symptoms of ovarian cancer - but everyone should. You can help by downloading and sharing our awareness poster.

More information

• Low-grade serous ovarian cancer
• Top 10 Tips for talking to your doctor (Produced by UK charity Target Ovarian Cancer)