Ovarian Cancer Symptoms and Early Warning Signs

Why ovarian cancer symptoms are easy to miss

The ovaries sit deep in the pelvis, and a tumor can grow for some time before it presses on nearby organs or causes fluid to build up in the abdomen. The symptoms it causes, such as bloating, indigestion and needing to urinate, are very common and usually due to harmless conditions. As a result, many ovarian cancers are found at a later stage.

The difference with ovarian cancer is that the symptoms are:

• new for you, not something you have had for years
• frequent, happening on most days (12 or more days a month)
• persistent, not coming and going with your period or meals

The main early warning signs

Persistent bloating

A feeling of swelling or fullness in the belly that does not come and go, or a visibly enlarged abdomen. Clothes may feel tight at the waist. This can be caused by the tumor or by fluid in the abdomen (ascites). Ordinary bloating usually fluctuates through the day and settles overnight.

Pelvic or abdominal pain

A dull ache or pressure in the lower belly, pelvis or sides that persists. It may be mistaken for period pain or constipation.

Feeling full quickly or loss of appetite

Feeling full after only a few mouthfuls, or not wanting to eat, often with indigestion or nausea.

Urinary symptoms

Needing to urinate more often or more urgently, because of pressure on the bladder.

Other possible symptoms

• tiredness and low energy
• lower back pain
• constipation or other changes in bowel habit
• unexplained weight loss, or weight gain around the middle
• pain during sex
• vaginal bleeding after menopause, or irregular bleeding
• breathlessness from fluid around the lungs, in advanced disease

Ovarian cancer symptoms vs common conditions

Irritable bowel syndrome rarely starts for the first time after age 50, so new IBS symptoms at that age should prompt testing for ovarian cancer.

Keep a symptom diary

If you are unsure, write down every day for 2 to 3 weeks whether you had bloating, pain, early fullness or urinary symptoms, and how severe they were. Take it to your doctor. Some ovarian cancer charities offer printable diaries for this purpose.

Who is at higher risk

• age over 50, especially after menopause
• inherited mutations in the BRCA1 or BRCA2 genes. See BRCA mutation
• Lynch syndrome
• a family history of ovarian, breast, bowel or womb cancer
• endometriosis
• never having been pregnant
• hormone replacement therapy for several years
• obesity and smoking (for some types)

Having risk factors does not mean you will get ovarian cancer, and many women who develop it have no known risk factors.

What to expect at the doctor

Tell your doctor which symptoms you have, how often and for how long, and mention any family history. The first steps are usually:

1. Abdominal and pelvic examination to feel for a mass or fluid.
2. CA-125 blood test: a protein that is often raised in ovarian cancer. It can also be raised by endometriosis, fibroids, periods, pregnancy and liver disease, and can be normal in early cancer, so it is not a diagnosis by itself.
3. Transvaginal ultrasound: to look at the ovaries and check for fluid.

If the results are concerning, you will be referred quickly to a gynecologic oncologist for a CT scan and further assessment. A diagnosis is confirmed by examining tissue from surgery or a biopsy. See ovarian cancer for types, stages and treatment.

Can ovarian cancer be screened for?

There is no effective screening test for women at average risk. Large trials found that routine CA-125 and ultrasound screening did not reduce deaths. A cervical screening (Pap) test does not detect ovarian cancer. Knowing the symptoms and acting on them is currently the best approach. Women with BRCA or Lynch mutations should discuss risk-reducing options with a specialist.

Frequently asked questions

What are the first signs of ovarian cancer?

The most common early signs are persistent bloating, pelvic or abdominal pain, feeling full quickly or loss of appetite, and needing to urinate more often. These symptoms matter most when they are new, happen on most days and last more than 2 to 3 weeks.

What does ovarian cancer bloating feel like?

It is a constant feeling of fullness or swelling in the belly that does not come and go like ordinary bloating. Your abdomen may look bigger and clothes may feel tight around the waist. It often comes with early fullness or pelvic discomfort.

Can a blood test detect ovarian cancer?

The CA-125 blood test can help, but it is not definitive. It is raised in many ovarian cancers but also in harmless conditions, and can be normal in early cancer. Doctors combine it with a pelvic ultrasound and, if needed, scans and a biopsy.

Does a Pap smear detect ovarian cancer?

No. A Pap smear or cervical screening test checks for changes in the cervix and does not detect ovarian cancer. If you have symptoms, ask your doctor about a CA-125 blood test and a pelvic ultrasound.

At what age does ovarian cancer usually occur?

Most ovarian cancers occur after menopause, and about half are diagnosed in women over 63. Women with BRCA mutations may develop it earlier. Rarer types, such as germ cell tumors, can affect girls and young women.