You might assume a condition as serious as cancer would trigger symptoms of a similar magnitude—but that’s not always the case, particularly when it comes to the ovarian kind.
“Ovarian cancer has been known as the ‘silent killer’ because many women do not experience symptoms until after it is already widespread and considered advanced,” Eloise Chapman-Davis, MD, a gynecologic oncologist at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF. And when symptoms do crop up, they can be deceivingly vague.
It’s a big reason why only around 20% of ovarian cancers are diagnosed in early stages, which is when it’s confined to the ovaries or fallopian tubes (where most ovarian cancers actually start). The rest are detected later on, when the cancer cells may be less responsive to treatments like chemotherapy. Hence why ovarian cancer is the deadliest of all gynecologic cancers—though it’s relatively rare, affecting just about 20,000 women in the US each year, it’s also the fifth-leading cause of cancer-related deaths for this demo.
And yet, when ovarian cancer is detected early, about 94% of patients live longer than five years after diagnosis. Read on to learn the subtle symptoms of ovarian cancer to look out for, as well as the preventative steps you may be able to take to reduce your risk.
It’s worth reiterating that plenty of people with ovarian cancer might not have symptoms, especially at the early stages, and that’s largely because of where it grows.
Upwards of 90% of ovarian cancers are the epithelial type, which means they occur in the tissue that coats the surface of the ovaries, or as scientists have recently discovered, start in a fallopian tube and then move to the top of the ovary. “You don’t have a sensory nervous system in either place, so you wouldn’t necessarily feel anything wrong, particularly if the tumor is small,” Christina Annunziata, MD, PhD, senior vice president of Extramural Discovery Science at the American Cancer Society (ACS), tells SELF. (The two other types of ovarian cancer—germ cell and stromal cell—are very rare and occur inside the ovaries, where they tend to cause much sharper abdominal pain, Dr. Annunziata points out.)
Generally, it takes time before the typical ovarian tumor grows big enough and takes up enough space in your pelvis to cause symptoms, Dr. Chapman-Davis says. And even then, the symptoms can be pretty nonspecific and easy to chalk up to other conditions, she notes. Some of the most common ones include:
Your stomach or pelvis feels unusually puffed-out, or you feel like your pants aren’t fitting correctly, but you’re not putting on weight anywhere else, Dr. Annunziata explains. This can occur as the cancer starts to spread from your ovaries to other parts of your abdomen.
Feeling nauseated or getting full quickly when eating
You might feel like food doesn’t taste as it should or doesn’t sit well anymore, Dr. Annunziata says. That might lead you to eat less, so you could wind up losing weight, too—even as you experience bloating or stomach swelling at the same time, she points out.
Peeing frequently or feeling a constant urge to do so
Feeling like you have to go all the time but can never quite empty your bladder completely is another sign, typically caused by the way the body can hold onto fluid when fighting cancer, Dr. Annunziata says. This might show up as waking up constantly to pee, too.
Pelvic or stomach pain
As an ovarian tumor grows, it can start to press on other organs in your pelvis and potentially push up against a nerve, which can trigger an achy pain, Dr. Annunziata notes. (It’s typically nagging though not necessarily sharp.)
A few other less-common ovarian cancer symptoms include:
The tricky thing is, these symptoms can apply to so many different health conditions (including irritable bowel syndrome and urinary tract infections), or even something like eating too much at dinner. So experiencing them doesn’t mean you immediately need to worry about ovarian cancer, Shannon N. Westin, MD, MPH, a clinical investigator in the department of gynecologic oncology and reproductive medicine at MD Anderson Cancer Center, tells SELF.
What you want to be aware of is if these symptoms seem to pop up out of nowhere (meaning, you can’t attribute them to an existing health condition or behavior) and stick around. In particular, if you’re having any of the above more than 12 times a month, the ACS recommends seeing a doctor. (You can of course still check in with your doctor if they’re occurring less often but you’re concerned about them.)
Unfortunately, there’s no equivalent to a mammogram for breast cancer or an HPV test for cervical cancer when it comes to the ovarian kind.
The only screening tests out there are technically diagnostic—meaning they’re done in folks who have symptoms, when a doctor suspects ovarian cancer might be lurking—or occasionally recommended for people at higher-than-average risk for ovarian cancer (for instance, if you have a family history of ovarian or breast cancer, or an inherited genetic condition, like Lynch syndrome or a BRCA gene mutation). And even in these scenarios, it’s worth noting, the tests are far from perfect; research hasn’t proven that using them for screening actually reduces the risk of dying from ovarian cancer.
One of the most common is a transvaginal ultrasound, which uses sound waves to look at organs like your ovaries, fallopian tubes, and uterus. But even if this ultrasound does pick up on an ovarian growth, that doesn’t tell you whether the tumor is cancerous (and most of the growths found by transvaginal ultrasound are benign). The other one typically used is a CA-125 blood test, which measures the amount of a protein called CA-125 in your blood. It’s often elevated in people with ovarian cancer—but it can also spike as a result of inflammation triggered by conditions like endometriosis, pelvic inflammatory disease, uterine fibroids, and ovarian cysts (all of which are much more common than ovarian cancer).
In the future, we may have more accurate screening options, Dr. Annunziata points out. Researchers are currently exploring tests for certain proteins and other markers in the blood that might indicate ovarian cancer. But they haven’t landed on one quite yet.
Your best defense is to keep up with those yearly gyno visits. During a pelvic exam, your doctor will feel your ovaries and uterus and may be able to detect a mass, Dr. Annunziata says. It’s not foolproof—plenty of growths, particularly small ones, might evade a gynecologist’s touch—but it’s still better to get examined than not.
It’s also smart to check in with your doctor if you suspect you fall in the high-risk bucket, as they may recommend taking steps to prevent ovarian cancer. If you’re not aiming to have kids anytime soon, that might include getting on a hormonal birth control pill (if you aren’t already), Dr. Annunziata says. Research suggests women who’ve used oral contraceptives have a 30 to 50% lower risk of ovarian cancer than those who haven’t. And if you’re done having kids or don’t plan to have any, your doctor may suggest a salpingectomy, or removal of your fallopian tubes (which is distinct from tubal ligation, a.k.a. having your tubes tied). Studies show it can slash your risk by as much as 80%, Dr. Annunziata points out.
Otherwise, “the most important thing is to be attuned to your body for any changes and then to be a self-advocate,” Dr. Annunziata says. If you flag persistent or strange symptoms to your doctor and they seem to brush you off, keep pushing for an answer or try to get a second opinion. Doctors are knowledgeable, but you know your body best. If you’re really worried that something is wrong, any doctor you see should take that seriously.
