Early symptoms of ovarian cancer

The early symptoms of ovarian cancer are something women should always watch out for, and especially on Gynecologic Cancer Awareness month. This can be difficult, though. The early stages of ovarian cancer may be devoid of any symptoms – and when there are symptoms, they may be mistaken for those of constipation or irritable bowel. Hence women must, on the one hand know their bodies well and what is normal for them and, on the other pay close attention to any abnormal occurrences. The earlier cancer is found the earlier it can be treated and the better the prognosis will be. Approximately 20% of ovarian cancers are detected at an early stage, and when found at a localized stage about 94% of patients live longer than 5 years after being diagnosed.

Ovarian cancer symptoms include:

  • Abnormal vaginal bleeding or discharge.
  • Bloating or swelling in the abdomen.
  • A feeling of fullness quickly after eating.
  • Loss of weight.
  • Discomfort in the pelvis.
  • Constipation, diarrhea, and other changes in bowel habits.
  • Frequent and /or urgent need to urinate.
  • Back pain.
  • Fatigue.
  • Indigestion.
  • Pain during intercourse.
  • Irregular menstruation.

Risk factors for ovarian cancer

Age

  • 68% of women who develop ovarian cancer are older than 55 years old.
  • 32% of women who develop ovarian cancer are younger than 55 years old.
  • Rare in women younger than 40 years old.

Weight

  • Women in their early adulthood who are obese (body mass index of at least 30) are 50% more likely to develop and die from ovarian cancer.

Race

  • North American, Northern European, or Ashkenazi Jewish women

Family history

  • Having a first-degree relative on either side of the family with ovarian cancer triples the risk.

Previous history of cancer

  • Having had breast, uterine, colorectal, or cervical cancer, or melanoma.

Reproductive history

  • Having never been pregnant.
  • Having had trouble getting pregnant (infertility).
  • Having a first full-term pregnancy after the age of 30.

Birth control

  • Having never used oral contraceptive pills.

Menstruation

  • A woman who started menstruating before age 12 or experienced the onset of menopause after age 54 (or both) may have a higher risk.

Inherited genetic mutations

  • BRCA 1.
  • BRCA 2.
  • One associated with Lynch syndrome.

Genetic conditions

  • Peutz-Jeghers syndrome.
  • Nevoid basal cell carcinoma syndrome.
  • Li-Fraumeni syndrome, and ataxia-telangiectasia.
  • PTEN tumor hamartoma syndrome .
  • MUTYH-associated polyposis.

Endometriosis

  • When the inside of the uterus grows outside of the uterus it can affect nearby organs.

Hormones

  • Estrogen-only hormone replacement therapy.
  • Male hormones called androgens.

 

How to avoid ovarian cancer risks

  • Using oral contraceptive pills.
  • Undergoing a tubal ligation, a hysterectomy, or having both ovaries removed.
  • Becoming pregnant and carrying the pregnancy to full term before age 26.
  • Breastfeeding.

In spite of all of the above, most women experience the early symptoms of ovarian cancer without being at high risk. For example, women of all ages can develop this type of cancer. Similarly, there is no one effective method for the prevention. Accordingly, the ones listed above are not recommended as means of preventing ovarian cancer. However, being aware of the symptoms and risk factors can lead a woman to get tested and possibly detecting the disease early. Keep in mind that there are no specific screening tests for women who do not show any signs of ovarian cancer. For instance, a Pap smear is used to screen for cervical, but not for ovarian cancer.

Tests used to confirm or deny a suspected ovarian cancer include the following:

  • Pelvic examination.
  • Transvaginal ultrasound.
  • Blood tests.
  • X-ray.
  • CT scan.
  • PET scan.
  • Lower gastrointestinal series.
  • Biopsy.
  • MRI.

There is also the possibility of having a genetic test to check for ovarian cancer. However, genetic testing is not for every woman – in fact, it is useful for only a small fraction of women with a family history of ovarian cancer. Overall, there are two main reasons – and for each a subset of reasons – why you should consider genetic testing:

If you have an Ashkenazi

Jewish background, and on your mother’s or

father’s side you have:

 

If you do not have an Ashkenazi

Jewish background, but on your mother’s or

father’s side you have:

 

  • A first-degree relative with breast or ovarian cancer; or,
  • Two second-degree relatives on the same side of the family with breast or ovarian cancer.
  • Two first-degree relatives with breast cancer and at least one of  them was diagnosed at or before 50 y/o.
  •  A combination of three or more first- or second-degree relatives with breast cancer, regardless of age.
  • A combination of breast and ovarian cancer among first- and second-degree relatives.
  • A first-degree r elative with breast cancer in both breasts.
  • A combination of two or more first- or second-degree relatives with ovarian  cancer, regardless age.
  • A first- or second-degree r elative with both breast and ovarian cancer, diagnosed at any age.
  • A history of breast cancer in a male relative

In case that there is ovarian cancer, diagnostic tests can also help to stage it. This cancer begins in the ovaries, which are located one on each side of the uterus. But the tumor can spread to other parts of the body (metastasis). Staging the cancer allows the doctor to assess the size and location of the tumor.

Stages of ovarian cancer

Stage

Description

I

Cancer is only located in one or both ovaries.

IA

Cancer is found in only one ovary and has not spread to the pelvis, abdomen, nearby lymph nodes, or distant organs.

IB

Cancer is found in both ovaries but has not spread to the pelvis, abdomen, nearby lymph nodes, or distant organs.

IC

Cancer is found in one or both ovaries. One of the three following is possible:

  • Ruptured capsule; or,
  • Spread to the ovarian surface; or,
  • Cancerous cells in the abdominal fluid.

II

Cancer is found in both ovaries and has spread elsewhere in the pelvis.

IIA

Cancer has spread to the uterus or fallopian tubes, but not to lymph nodes in the pelvis or to distant parts of the body.

IIB

Cancer has spread to other pelvic tissue and regional organs (bladder, sigmoid colon, rectum) but not to lymph nodes or distant sites.

IIC

Cancer has spread to the pelvic area and is casting off cancerous cells into the abdominal fluid.

III

Cancer is found in one or both ovaries and the pelvis and has spread to the abdomen or the peritoneum.

IIIA1

Cancer is found in one or both ovaries or fallopian tubes, and may have spread to nearby pelvic areas. Spread is observed in retroperitoneal lymph nodes but not in other areas.

IIIA2

Cancer is found in one or both ovaries or fallopian tubes, and may have spread to nearby pelvic regions and microscopically into the peritoneal cavity.

IIIB

Cancer is found in one or both ovaries or fallopian tubes and has spread into the peritoneal area with tumor growth of 2 cm or smaller and may have grown into nearby pelvic organs.

IIIC

Cancer is found in one or both ovaries or fallopian tubes, and has either spread into the peritoneal area with areas of growth larger than 2 cm or to the retroperitoneal or inguinal lymph nodes. It has not spread to the inner liver or spleen or distant organs.

 

Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging

Stage

Description

I

Cancer is only found in the ovaries.

IA

Cancer is only in one ovary and not found on the surface of the ovary or the abdominal area.

IB

IC

Limited to one ovary.

IC1

Cancer spreading during surgery.

IC2

Cancer is located outside the ovary or the ovary has ruptured.

IC3

Cancerous cells are found in the abdomen.

II

Cancer is found in one or both ovaries and has spread below the pelvis.

IIA

Cancer has grown into the outside of the uterus or fallopian tubes.

IIB

Cancer has grown into other tissues below the pelvis.

III

Cancer is found in one or both ovaries and has spread outside the pelvis and nearby lymph nodes.

IIIA

Cancer has grown into the lymph nodes behind the abdomen, with or without spreading to the abdomen.

IIIB

Cancer has grown into the lymph nodes behind the abdomen and is less than 2cm, with or without spreading to the abdomen.

IIIC

Cancer has grown beyond the pelvis to the abdomen and is larger than 2cm, with or without spreading to the abdominal area.

IV

Cancer has grown into organs past the ovaries except the abdomen.

IVA

Cancer has spread to fluid around the lungs.

IVB

Cancer has grown past the abdominal organs.

 

Ovarian cancer survival rates by stage

 

Stage

Relative five-year survival rate %

Invasive epithelial ovarian cancer

I

90

IA

94

IB

92

IC

85

II

70

IIA

78

IIB

73

III

39

IIIA

59

IIIB

52

IIIC

39

IV

17

 

Ovarian stromal tumors

I

95

II

78

III

65

IV

35

 

Germ cell tumors of the ovary

I

98

II

94

III

87

IV

69

 

Fallopian tube carcinoma

I

87

II

86

III

52

IV

40

The stage of ovarian cancer will help the doctor – more specifically, a gynecologist oncologist – determine the course of treatment to follow.

Treatment by stage

Stage I

  • Surgery
  • Surgery and chemotherapy.

Stage II

  • Surgery.
  • Surgery and adjuvant chemotherapy.

Stages III & IV

  • Surgery and adjuvant chemotherapy.
  • Neoadjuvant chemotherapy.
  • Only chemotherapy.

 

Treatment options

Surgery

  • Salpingo-oophorectomy.
  • Hysterectomy.
  • Lymph node dissection.
  • Omentectomy.
  • Cytoreductive/debulking surgery.

Adjuvant chemotherapy

Reduces the size of the tumor prior to surgery.

Neoadjuvant chemotherapy

Destroy the remaining of the tumor following surgery.

Additional treatment alternatives include radiation therapy, hormone therapy, and targeted therapy.

 

Related Read:

- Early symptoms of vulvar cancer

- Early symptoms of uterine cancer

- Early symptoms of cervical cancer