How to recognize possible symptoms of ovarian cancer


Do you know the symptoms and warning signs of ovarian cancer? Dr. Jennifer Wu, an OB/GYN at Lenox Hill Hospital in New York explains the latest medical advice about detection and screening.

How to recognize possible symptoms of ovarian cancer

Early detection and treatment of ovarian cancer can result in a cure rate as high as 90 to 95%, and doctors now believe that there are symptoms and warning signs that may help detect it earlier.

However, if ovarian cancer is not diagnosed until an advanced stage, it has the highest mortality rate of any genital cancer, (Unfortunately, for diagnosis at an advanced stage, five-year survival rates can be as low as 20%.) Ovarian cancer is frequently called the "silent killer" because there is no absolute, medically conclusive physical exam, blood test or diagnostic tool to detect it early, and surgical excision and pathology study after the disease has progressed may be the only way to definitively diagnose ovarian cancer.

Staging in the discussion of ovarian cancer refers to the location of the cancer and how advanced it is. Ovarian cancers are labeled from Stage I (Early) which means that the cancer is confined just to the ovaries, to Stage IV (Advanced) which means the cancer has spread to other organs in the body.

Key Symptoms and Warning Signs

  • Bloating and distension
  • Abdominal pain
  • Increase in abdominal girth
  • Increased frequency of urination or other urinary symptoms

Note that some of these symptoms are very common, not indicative of ovarian cancer, and women are likely to experience them at some point. However, the key difference to pay attention to is persistence: Does the symptom last for more than a month? If so, get to a doctor right away. If you see your primary care physician --- rather than your gynecologist -- make sure you are very specific when describing your symptoms. Especially their duration. After an exam where your physician will physically feel for abnormalities in shape or size of internal organs, there are other tests you and your physician may want to consider if there is any suspicion of ovarian cancer.

Diagnostic Tools and Tests
  1. Sonogram - A diagnostic image created using ultrasound equipment
  2. CA-125 blood test. CA (Cancer Antigen) 125 is present in greater concentrations in ovarian cancer cells than in other cells, but this test is good only for perimenopausal or menopausal women. (It can be falsely elevated in younger women as ovulation causes the reading to be high despite the absence of ovarian cancer.)
  3. Detailed family history and genetic testing. A history of ovarian cancer in your family predisposes you to a higher risk of developing ovarian cancer, as does a history of breast cancer. In addition, genetic testing (BRCA 1 & 2) may also provide an indication of increased risk for developing ovarian cancer.

Note that medical science is still looking for a test that can detect ovarian cancer at an early stage, and none of these existing tests are medically conclusive.

If diagnosed early enough, ovarian cancer is treated with surgical excision (removal) of the ovaries in conjunction with chemotherapy.

If the cancer has spread beyond the ovaries, surgery and chemotherapy can cause the disease to go into a remission. However, it is possible that not all the cancer cells will be removed through this treatment, and patients may experience a relapse. If this occurs, the usual treatment is additional chemotherapy.

What should you do?
Because there is not, yet, a great screening test suitable for widespread use, the best "preventive medicine" you can practice to help in the early detection of ovarian cancer is an annual check up with your gynecologist. Pay particular attention to the symptoms and warning signs, and don't hesitate to schedule an appointment sooner than one year if you have any concerns about symptoms or warning signs that persist.

DENISE: Hello there I'm Denise Richardson for Ovarian cancer has been called the silent killer because by the time it's discovered, it's often already advanced. But doctors now believe that there are some symptoms and warning signs to help detect it earlier. Here to help us recognize the signs of ovarian cancer is gynecologist Dr. Jennifer Wu. Dr. Wu thank you for being with us. How many women are getting ovarian cancer every year?

DR. WU: In 2002, there were 23,000 cases diagnosed. So overall numbers are small, but the mortality is very high because usually the cancer is at an advanced stage at diagnosis.

DENISE:  I recently had a girlfriend who was recently diagnosed with ovarian cancer. One of the symptoms that she said she had was bloating. And you know in retrospect over the last couple of years if she had known that was a symptom she would have gone to the doctor. What are the other symptoms?

DR. WU: Some of the other symptoms of ovarian cancer include abdominal pain, increase in abdominal girth, bloating, distention, sometimes urinary symptoms, frequency of urination. 

DENISE:  Can they be the kind of symptoms that can appear to be something else?

DR. WU: Unfortunately these are very common symptoms. If you ask patients, have you ever had bloating, most patients will say oh yes at one point or another. I think to try to determine the difference whether it's an ongoing problem and persistant. For more than a month. Oftentimes patients will go to a primary care doctor, not necessarily to their gynecologist and they need to be a little bit specfic about how long they've been having the symptoms. The doctor will generally do a medical exam and order a sonogram if there's anything suspicious with it. 

DENISE:  So is that the only testing, the medical exam, the sonogram, what other testing is involved?

DR. WU:  There's also a blood test called the CA-125. It's a good test for patients who are perimenopausal or menopausal. CA-125 can be falsely elevated in younger patients by things like ovulation which occurs every month. So it's a more specific test for older patients. And that can help us to determine whether this could be an ovarian cancer problem or not. Unfortunately it doesn't detect early ovarian cancer, so we're still looking for the ideal test to detect early ovarian cancer. 

DENISE: Are those tests always conclusive?

DR. WU:  Unfortunately physical exams, sonograms, CA-125, these are not conclusive. The only way to be conclusive is to do a surgical exicison and then study the specimen in pathology.

DENISE: Who is predisposed to ovarian cancer?

DR. WU:  Certain patients who have a family history. There's something called BRCA 1 and 2 and these are genetic markers that can show that a patient is more predisposed to ovarian cancer. Patients with family history, patients with a personal history of breast cancer. 

DENISE:  And what's the prognosis? What's the treatment for ovarian cancer? 

DR. WU:  The treatment for ovarian cancer is surgical excision often in conjunction with chemotherapy. If ovarian cancer is caught in the early stage, stage 1, cure rates are great, 90 to 95 percent. But unfortunately most ovarian cancer is caught at an advanced stage and five years survival is something as low as 20 percent. 

DENISE:  What is an early stage?

DR. WU:  So staging with ovarian cancer is related to where the cancer is. Early cancer, or stage 1, means that the cancer is just confined to the ovary. In advanced stages, the cancer has spread to adjacent organs and things like that, like the intestines, the liver, the lungs. So it becomes very difficult to treat cancers once they've spread beyond the ovary and spread to other body parts. 

DENISE:  Chemotherapy is not helpful in that circumstance. 

DR. WU:  Patients are usually treated with surgical excision and chemotherapy, but usually it doesn't get all of the cells, so then patients will experience a relapse, the ovarian cancer comes back. Then they may need additional chemotherapy. 

DENISE: When a woman goes to her gynecologist and maybe she doesn't have a family history of ovarian cancer, she's simply scared of the possibility given the statistics out here, what should she do?

DR. WU: Unfortunately we don't have a great screening test in terms of sonograms or blood tests or anything like that, that could be used for the widespread population that could be used to prevent ovarian cancer. We're still working on that. But, I think that patients that try to take care of themselves and go for annual checkups, we have a better chance of finding ovarian cancer early in them. 

DENISE:  Dr. Wu thank you very much for being with us. I'm Denise Richardson for 



meet theexpert
  • Dr. Jennifer Wu

    Dr. Jennifer Wu Obstetrician-Gynecologist Dr. Jennifer Wu is a practicing board-certified obstetrician-gynecologist in New York City. She is a Fellow of the American College of Obstetrics and Gynecology and a member of the American Medical Association and the New York Country Medical Society. more about this expert »

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