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What are the symptoms of ovarian cancer?

In New Zealand one person is diagnosed with ovarian cancer every day and five die every week. That makes it the leading cause of gynaecological cancer death and the fifth most common cause of cancer death overall, in females.

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.

Any female or person born with ovaries/fallopian tubes is at risk of developing ovarian cancer.

Even if you have had surgery to remove your ovaries or fallopian tubes, or you take treatment to suppress ovarian function - you can still develop ovarian cancer.

Cervical screening does not check for ovarian cancer

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

When should I see my GP?

Many of these symptoms are common and usually caused by conditions other than ovarian cancer. But you should take note of any changes especially if they are NEW, UNUSUAL or GETTING WORSE. If the change has not gone away after TWO WEEKS then you should get it checked out.  Ovarian cancer is more treatable when it is found early.

Everyone's normal is different. You know your body best.

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

Unfortunately in New Zealand people with ovarian cancer often report that they have to see a doctor several times before being tested for ovarian cancer. 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 (younger age is a risk factor for misdiagnosis).

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

The first test a doctor will do for ovarian cancer is 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.

Pelvic exam depiction

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

An abnormal finding does not necessarily mean that you have ovarian cancer - but you should be prioritised for an ultrasound - usually within two weeks.

A normal pelvic exam does not rule out ovarian cancer - you still need further testing.

Blood test

The next step is a 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.

Sometimes other blood tests are also ordered including CEA and CA19-9. But CA-125 is the most likely to be abnormal if the symptoms are due to ovarian 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

The next step to check for ovarian cancer is a referral for a pelvic and trans-vaginal ultrasound. A doctor can refer you publicly or privately. In the public system how quickly you are seen will depend on the result of your CA-125 blood test and pelvic exam. Unfortunately our research has found that where you live, can also have a significant influence.

The cost for a private ultrasound is about $300 and is usually quicker. If you can afford to go private (or have health insurance) this is usually the recommended option.

An ultrasound is a safe and painless test which uses sound waves to create images of structures inside your body.

You may 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.

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, many doctors will recheck the CA-125 blood test 4 to 12 weeks later.

It is very important to let your doctor know if your symptom(s) get worse (even if you are waiting for a specialist appointment).

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 women/people, 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.

Factors that Mildly Alter Risk

Increased risk

  • Older age (but some types of ovarian cancer are more common in younger women)
  • Endometriosis
  • Being overweight
  • Never being pregnant

Reduced Risk

  • Hormonal contraceptive use
  • Healthy weight
  • Giving birth
  • Pregnancy/breast feeding

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?

When we say ovarian cancer we mean cancer of the ovary, fallopian tube and peritoneum (lining of the abdomen). Ovarian cancer commonly develops from the epithelial (surface cells), stromal (connective tissue) or germ cell (reproductive cells).

The World Health Organisation recognises over thirty different types of ovarian cancer including high-grade serous, low-grade serous, clear cell, mucinous, endometrioid, germ cell and more. Though they all have similar symptoms and are diagnosed the same way - they are essentially unique cancers that develop differently and respond differently to treatment. In addition, there is also a condition called borderline tumours which while not cancer, are diagnosed in the same way and also managed by the gynaecological oncology service.

Share the symptoms

Most people in New Zealand are unable to name any symptoms of ovarian cancer but it's important knowledge they need to know. We have put together a symptoms resource with posters and social media posts you can use to share the symptoms. We have printed symptoms cards and posters that we are happy to pop in the post too -  you just need to ask.

More information

Cure Our Ovarian Cancer

Is NZ's only dedicated ovarian cancer charity. We work with health practitioners, researchers, and patients to improve ovarian cancer outcomes by targeting three key areas: increasing awareness; providing advocacy and support for women with ovarian cancer; and supporting ovarian cancer research.

If you've found this information helpful please consider making a donation so we can help more people.

Cancers with overlapping symptoms

If this information wasn't quite what you were looking for -  here is a list of other cancers which can also cause vague abdominal symptoms: bowel cancer, uterine cancer, pancreatic cancer, liver cancer, stomach cancer, kidney cancer, bladder cancer. You may also like to learn more about endometriosis.

It's important to know that ovarian cancer can only be ruled out - if you are tested for it.