Ovarian cancer can be difficult to recognize because its symptoms may resemble common digestive, urinary or gynecologic conditions. Understanding what changes to notice, when to seek evaluation and how ovarian cancer is diagnosed can help you take an informed role in your care.
About Ovarian Cancer
Ovarian cancer includes several types of cancer that develop in the ovaries or closely related tissues. The most common are epithelial cancers, which arise from cells associated with the surface of the ovary, fallopian tube or peritoneum, the tissue that lines the abdominal cavity. Ovarian epithelial, fallopian tube and primary peritoneal cancers are closely related and are generally evaluated and treated using similar approaches.
Other, less common ovarian cancers develop from different types of ovarian cells and may behave and respond to treatment differently. Determining the specific type of cancer is therefore an important part of diagnosis and treatment planning. At Saint John’s Health Center, we are committed to a correct diagnosis so that your recommended treatment plan can provide the most optimal outcome.
Signs and Symptoms of Ovarian Cancer
Symptoms of ovarian cancer can be subtle, particularly because many are also associated with common noncancerous conditions. Rather than trying to identify ovarian cancer from a single symptom, pay attention to changes that are new for you, occur frequently, persist or become progressively worse.
Possible signs and symptoms include:
- Persistent abdominal or pelvic bloating or swelling
- Pelvic or abdominal pain, pressure or discomfort
- Difficulty eating or feeling full more quickly than usual
- Changes in urinary frequency or urgency
- Changes in bowel habits, including constipation
- Back pain
- Unexplained fatigue or changes in weight
- Unusual vaginal bleeding or discharge
Are There Early Symptoms of Ovarian Cancer?
Ovarian cancer does not always cause obvious symptoms early in its development, but symptoms can occur before the disease is advanced. Bloating, pelvic or abdominal discomfort, difficulty eating or feeling full quickly, and urinary changes are among the symptoms that may occur.
These symptoms do not indicate how advanced a cancer may be, and having one or more does not mean that ovarian cancer is present. Their significance depends on the pattern of symptoms, your medical history and what is normal for you.
When Should You Seek Evaluation?
Many symptoms associated with ovarian cancer have much more common causes. What matters is recognizing when something has changed from what is normal for you and knowing when that change deserves medical attention.
Talk with your healthcare provider if abdominal, pelvic, digestive or urinary symptoms are new, persistent, occur frequently or become worse without a clear explanation. Unusual vaginal bleeding should also be evaluated. Your provider can consider the pattern of your symptoms together with your medical history and determine whether additional evaluation is appropriate.
Seeking evaluation does not mean that cancer is expected. It provides an opportunity to identify the cause of persistent symptoms and determine whether further testing is needed.
Risk Factors for Ovarian Cancer
Most people who have risk factors for ovarian cancer will never develop the disease, and some people who develop ovarian cancer have no obvious risk factors. Risk factors help clinicians understand patterns of disease and identify people who may benefit from additional counseling or evaluation; they cannot determine whether an individual has cancer.
Factors associated with increased ovarian cancer risk can include:
- Increasing age
- A personal or family history of ovarian, breast or certain other cancers
- Inherited genetic changes associated with ovarian cancer risk, including BRCA1 and BRCA2
- Certain inherited cancer syndromes, including Lynch syndrome
- Endometriosis, particularly in relation to certain ovarian cancer types
- Some reproductive and hormone-related factors
Inherited Risk and Genetic Testing
Some ovarian cancers are associated with inherited genetic changes that can be passed through families. BRCA1 and BRCA2 are well-known examples, but other inherited genetic changes can also increase ovarian cancer risk.
If you have ovarian cancer or a personal or family history that suggests inherited cancer risk, genetic counseling and testing may provide information that affects your care and may also be relevant to family members. Your care team can help determine what type of genetic evaluation is appropriate.
How Ovarian Cancer Is Evaluated and Diagnosed
There is no single test that can diagnose ovarian cancer on its own. Evaluation typically begins with your symptoms, medical history and physical examination and may include imaging and blood tests. When cancer is suspected, diagnosis ultimately depends on examining cancer cells or tissue.
It is also important to distinguish screening from diagnostic evaluation. Screening looks for cancer in people who do not have symptoms. There is currently no reliable routine screening test for ovarian cancer in average-risk women without symptoms. Tests such as ultrasound and CA-125 may instead be used as part of an evaluation when symptoms, examination findings or other circumstances raise concern.
Pelvic Examination and Medical History
Your healthcare provider may ask about the pattern and duration of your symptoms, your medical and family history and other factors that could affect your risk. A pelvic examination may identify enlargement, a mass or other changes that require further evaluation, although an examination alone cannot diagnose ovarian cancer.
Imaging Tests
Ultrasound, particularly transvaginal ultrasound, can help evaluate the ovaries and other structures in the pelvis when a mass or other abnormality is suspected. CT and other imaging studies may be used to evaluate the abdomen and pelvis and help determine whether a suspected cancer has spread.
CA-125 and Other Blood Tests
CA-125 is a protein that may be elevated in the blood of some people with ovarian cancer. However, CA-125 can also be elevated because of noncancerous conditions and may not be elevated in every ovarian cancer. For these reasons, CA-125 cannot diagnose ovarian cancer by itself and must be interpreted in the context of other findings.
Confirming the Diagnosis
A definitive cancer diagnosis requires examination of cells or tissue by a pathologist. Depending on the clinical situation, tissue may be obtained during surgery or through another procedure. Pathology determines whether cancer is present and identifies the type and characteristics of the tumor, information that helps guide treatment planning.
Genetic and Molecular Testing
After ovarian cancer is diagnosed, genetic and molecular testing may provide additional information about inherited risk and characteristics of the tumor. These findings can help guide certain treatment decisions and may identify inherited genetic changes that could also be important for family members.
How Ovarian Cancer Can Spread
Ovarian cancer can spread from its original location to nearby pelvic and abdominal tissues. Cancer cells may spread across surfaces within the abdominal cavity, including the peritoneum, and may also involve nearby lymph nodes. More advanced cancer can spread to areas farther from the original tumor.
There is not a single organ-by-organ pathway that ovarian cancer follows, and the way a cancer behaves depends in part on its specific type and biological characteristics. Imaging, surgery and pathology can help your care team determine where cancer is present and how far it has spread.
Stages of Ovarian Cancer
Staging describes how far ovarian cancer has spread and helps guide treatment planning. The stage is determined using information from diagnostic testing and, for many patients, findings obtained during surgery and examination of tissue.
Stage I
Cancer is limited to one or both ovaries, or fallopian tubes.
Stage II
Cancer involves one or both ovaries or fallopian tubes and has spread to other tissues within the pelvis.
Stage III
Cancer has spread outside the pelvis into the abdominal cavity and/or to certain nearby lymph nodes.
Stage IV
Cancer has spread to more distant areas of the body. Your gynecologic oncologist can explain what your specific stage means and how it affects treatment recommendations.
Treatment for Ovarian Cancer
Treatment depends on the specific type of ovarian cancer, its stage and biological characteristics, as well as your overall health and individual needs. Surgery and systemic treatments such as chemotherapy are important components of treatment for many ovarian cancers, while targeted therapies and other approaches may be appropriate depending on the characteristics of the cancer and the clinical situation.
For patients who wish to preserve fertility, fertility-sparing treatment may be possible in carefully selected circumstances depending on the type and stage of cancer. These decisions require individualized evaluation with a gynecologic oncologist.
Learn More About Ovarian Cancer Treatment Options
Questions About Ovarian Cancer
Does ovarian cancer show up in blood work?
There is no blood test that can diagnose ovarian cancer by itself. CA-125 may be elevated in some ovarian cancers, but it can also be elevated because of noncancerous conditions and may remain normal in some people who have ovarian cancer. Doctors interpret blood-test results together with symptoms, imaging, examination findings and other clinical information.
Can ovarian cancer be found during a routine pelvic exam?
A pelvic examination may occasionally identify an enlarged ovary, mass or other abnormality, but it cannot reliably detect or rule out ovarian cancer. If your symptoms, medical history or examination raise concern, your healthcare provider may recommend imaging or other testing.
Is there a routine screening test for ovarian cancer?
There is currently no reliable routine screening test for ovarian cancer for average-risk women who do not have symptoms. People with certain inherited genetic changes or a strong family history may have different recommendations, which should be discussed with a healthcare provider or genetic counselor.
Moving Forward After an Ovarian Cancer Diagnosis
An ovarian cancer diagnosis can involve many new terms, tests and treatment decisions, but you do not need to understand everything at once. Knowing the specific type and stage of your cancer and bringing questions about your treatment options, priorities and concerns can help you participate in conversations with your care team and understand what comes next.
As your evaluation and treatment progress, additional information from pathology, genetic and molecular testing, imaging or surgery may further define your care. Your gynecologic oncologist and other members of your multidisciplinary team can explain what those findings mean and how they may affect your treatment plan.
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