Ovarian cancer is often described as a 'silent' disease, but many women experience symptoms before they are diagnosed. The challenge is that these warning signs can be subtle and easily mistaken for common digestive, urinary or hormonal problems.

Because symptoms such as bloating, abdominal discomfort and changes in bowel habits are so common, many women delay seeking medical advice. Yet experts say persistence is one of the most important clues.

'Ovarian cancer is commonly referred to as a "silent" disease. However, this term may be misrepresentative,' said Dr Robert Thompson, DO, MS, CPE, FAAFP, medical contributor at Care Point Boston.

'Many women report symptoms prior to the diagnosis of ovarian cancer. Symptoms reported by many women include mild or vague symptomatology that may include indigestion, menopause and stress.'

Knowing which symptoms deserve attention could help women seek assessment earlier, when treatment options are often broader.

Why Early Detection Is Difficult

Ovarian cancer develops in the ovaries, the organs that produce eggs and female hormones. Unlike some cancers, there is currently no routine screening test for women at average risk.

According to Cancer Research UK, around 7,500 women are diagnosed with ovarian cancer each year in the UK, and the disease is more common in older women, particularly after the menopause.

One reason it is often diagnosed at a later stage is that the ovaries sit deep within the pelvis, allowing tumours to grow before causing obvious symptoms.

Persistent Bloating

Many women experience occasional bloating after eating certain foods or during their menstrual cycle. The concern with ovarian cancer is persistent bloating that occurs frequently and does not improve.

Dr Thompson said persistent bloating is one of the symptoms that should raise concern.

Women often describe:

  • A swollen or enlarged abdomen
  • Tightness around the waist
  • Needing looser clothing despite no weight gain
  • Bloating that occurs most days rather than occasionally

If bloating continues for more than a few weeks, it is worth discussing with a GP.

Pelvic or Abdominal Pain

Ongoing pain or pressure in the lower abdomen or pelvis is another important symptom.

This discomfort may be:

  • Dull or aching
  • Intermittent or constant
  • Different from usual menstrual cramps
  • Associated with a feeling of heaviness in the pelvis

Because pelvic pain can have many causes, including fibroids, endometriosis or urinary infections, it is often not immediately linked to ovarian cancer. Persistent pain should nevertheless be evaluated.

Feeling Full Quickly

A symptom that many women find surprising is becoming full after eating only a small amount of food.

'Feeling full quickly even though you have eaten little food' is among the symptoms Dr Thompson said warrant medical assessment.

This early satiety may occur because pressure within the abdomen affects the stomach. Women may notice they cannot finish meals they would normally eat comfortably.

Urinary Urgency or Frequency

Needing to pass urine more often or more urgently can occur when an ovarian mass presses on the bladder.

Women may notice:

  • Frequent trips to the toilet
  • Sudden urgency
  • Passing only small amounts of urine
  • Symptoms that persist despite treatment for a suspected urinary infection

Urinary symptoms are extremely common and are usually not caused by ovarian cancer, but persistent changes should not be ignored.

Changes in Bowel Habits

Ovarian cancer can also affect the bowel. Symptoms may include:

  • Constipation
  • Diarrhoea
  • Increased wind
  • A change in usual bowel pattern
  • Abdominal discomfort associated with bowel movements

Dr Thompson noted that bowel changes become more concerning when they occur frequently and differ from what is normal for that individual.

The Importance of Persistence

One of the key messages from specialists is that a single episode of bloating or abdominal discomfort is unlikely to indicate ovarian cancer. The pattern matters.

'Symptoms that appear more than 12 times per month or persist for greater than two to three weeks should prompt a physician to evaluate,' Dr Thompson said.

'Although it is estimated that most women who present with these types of symptoms will not develop ovarian cancer, their symptoms cannot be ignored and should be evaluated.'

Keeping a symptom diary can help identify whether symptoms are becoming persistent.

Other Symptoms to Watch For

Additional symptoms that can occur include:

  • Unexplained fatigue
  • Back pain
  • Unintentional weight loss
  • Loss of appetite
  • Increased abdominal size

These symptoms are non-specific, which is why they can easily be attributed to other conditions.

Who Is at Higher Risk?

Several factors can increase the risk of ovarian cancer.

'Risk increases with advancing age, familial mutations in genes associated with increased risk for ovarian and breast cancers (i.e., BRCA1 and BRCA2), family histories of ovarian or breast cancer, and reproductive factors such as never having children,' Dr Thompson explained.

Women with a strong family history of ovarian, breast, pancreatic or prostate cancer may benefit from discussing genetic counselling with their doctor.

However, he emphasised that ovarian cancer can occur in younger women as well.

'Age is an insufficient determinant for determining whether investigation of symptoms is warranted,' he said.

A Common Myth About Smear Tests

Many women assume that a normal cervical screening test means they are unlikely to develop ovarian cancer. This is incorrect.

'An additional common myth includes that if an individual has had a normal Pap smear test, they are free of the potential for developing ovarian cancer,' Dr Thompson said.

'This is incorrect because a Pap smear test screens for cervical cancer and not ovarian cancer.'

Attending cervical screening remains very important, but it does not detect ovarian cancer.

How Ovarian Cancer Is Investigated

If a GP is concerned about symptoms, assessment may include:

  • A pelvic examination
  • Blood tests, including CA125 in some cases
  • Pelvic ultrasound scanning
  • Further imaging if needed
  • Referral to a gynaecology or gynaecological oncology specialist

Dr Thompson said accurate diagnosis requires 'a combination of clinical evaluation through a pelvic exam, ultrasonography, laboratory testing, and consultation with a Gynecologic Oncology Specialist'.

When Should You Seek Medical Advice?

You should arrange a medical appointment if you experience:

  • Persistent bloating
  • Pelvic or abdominal pain lasting several weeks
  • Feeling full quickly
  • Frequent urinary urgency or frequency
  • Persistent bowel changes
  • Unexplained weight loss or fatigue

Seeking medical advice does not mean you have ovarian cancer. Most women with these symptoms will have another cause, but assessment is important to identify the reason.

Final Words

Ovarian cancer is not always truly silent. Persistent bloating, pelvic pain, feeling full quickly, urinary changes and bowel changes can all be early warning signs that deserve attention, particularly when they occur frequently or continue for several weeks.

While these symptoms are often caused by less serious conditions, recognising them and seeking timely medical advice can help ensure that ovarian cancer is identified as early as possible, when treatment is generally more effective, and outcomes are often better.

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