While breast cancer is much more common, ovarian cancer is much more lethal, says Ron Drapkin, MD, PhD, director of the Ovarian Cancer Research Center at the University of Pennsylvania.
A big reason for that: Ovarian cancer tends to be diagnosed late. “We don’t yet have early detection tools for ovarian cancer, and most of its symptoms are non-specific,” Drapkin says. He explains that by “non-specific,” he means there are no warning signs or symptoms that will make a doctor think, “Oh, that’s ovarian cancer.”
Because of the non-specificity of the cancer’s symptoms, Drapkin says ovarian cancer is sometimes called a “silent killer.”
“But research shows most women [with ovarian cancer]were going to their doctors with symptoms for 6 or 9 months before their diagnoses,” he explains. “So the symptoms are there—they’re not silent—but because they’re non-specific and related to many other common conditions, those common conditions usually have to be ruled out first.” (Want to pick up some healthier habits? Sign up to get healthy living tips delivered straight to your inbox!)
“The ovaries are located in the pelvis near the bladder and intestines,” Drapkin explains. “So when tumors grow, the symptoms that usually emerge are gastrointestinal issues related to the tumor pressing on those organs.”
Bloating, indigestion, and nausea are all common. “Some women complain of abdominal or lower back pain,” he says. Urinating or moving your bowels more often than you’re used to are also associated symptoms.
Ditto swelling in your abdomen and pelvis, feeling like your belly is distended, and a loss of energy or appetite, says Tiffany Troso-Sandoval, MD, a medical oncologist with Memorial Sloan Kettering Cancer Center.
“It’s important to know your body well,” Drapkin says. We all feel one or several of these symptoms now and then. “But if a few weeks or months pass, and these symptoms are persistent and not in the range of normal for you, then that’s when you need to see a doctor.”
Troso-Sandoval agrees, and says everything from hypothyroidism to sleep apnea—not to mention run-of-the-mill indigestion—could trigger these sorts of GI symptoms.
“The persistence of them—that they don’t wax and wane—that’s what really sets these symptoms apart from what you’d experience with other health conditions,” Drapkin adds.
Even if your symptoms have been hanging around for months, your doc is going to start by eliminating the likeliest causes—none of which is ovarian cancer.
“Common things happen commonly, while ovarian cancer is relatively rare,” Drapkin says. “So your doctor will need to rule out those common things first.”
If treatments for those conditions don’t resolve your symptoms, that’s when your doctor will order an ultrasound or a blood test to look for markers of cancer, Drapkin says.
“That timeline might change if you have a genetic risk for ovarian cancer—like a family history or a positive BRCA test,” he says. In that case, your doctor may go looking for ovarian cancer sooner.
But if you’re not genetically predisposed to cancer, don’t let an occasional upset stomach, bloating, or fatigue freak you out. “Most of these symptoms point to issues that have nothing to do with your ovaries,” Drapkin assures.