8 Early Signs of Ovarian Cancer, According to Doctors and Women Who've Experienced Them
First: What is ovarian cancer?
Ovarian cancer is the fifth most-deadly type of cancer among women, and this year, over 20,000 women in the United States will be diagnosed with it, per the American Cancer Society.
The ovaries are made up of three different types of cells: epithelial cells, germ cells, and stromal cells—all of which can develop into a cancerous tumor. However, in the earliest stages of ovarian cancer, the cells exist on a microscopic level, so it’s very difficult to catch.
Recognizing the symptoms of ovarian cancer can lead to a diagnosis in an earlier, more curable stage. The most important thing, according to Rebecca Brightman, MD, assistant clinical professor of obstetrics, gynecology, and reproductive science at Mount Sinai, is listening to your body. “Women, in general, know what’s normal for them,” she tells Health. “And that, for me, is one of the more helpful things in my practice. If someone comes in saying, ‘this is not normal, there is a change,’ then that person needs to be evaluated.”
It’s important to listen to your body and go to the doctor if you do notice something abnormal, because most ovarian cancer cases are diagnosed in the later stages. “About one in five women that have ovarian cancer, by rule of thumb, right now, will be diagnosed at an early stage,” Mary Rosser, MD, assistant professor of obstetrics & gynecology at Columbia Medical School, tells Health. “The benefit of being diagnosed early is that you have [a better chance at] survival, because you’ll have earlier, better treatment.”
Because early diagnosis is key to a successful treatment plan, we spoke to real women about the changes they noticed in their bodies ahead of their cancer diagnosis, and gynecologists about what these signs mean.
Bloating is the main symptom that puts doctors on high alert, Dr. Rosser says.
“It all started when my stomach felt bloated and wouldn’t go down,” says Ashley, now 29. “I ignored it, thinking it had to do with my period or my unhealthy diet. But the bloating wouldn’t go away.”
The little belly Ashley always had started to expand. By the time she visited her gynecologist for an annual checkup two months later, the tumor in her abdomen had grown to the size of a watermelon, covering her right ovary and kidney.
Sheryl, now 55, also found herself “blowing up” in the months leading to her diagnosis: “I knew I was putting on weight because my pants wouldn’t zip,” she remembers. “But I just thought I was getting older and, since my period was suddenly coming often, I figured that was bloating me too.”
Within a few months, Sheryl says she looked like she was six months pregnant thanks to ascites, or fluid buildup that can gather in the abdomens of some people with liver disease or cancer.
If a woman comes into her office with bloating, Dr. Rosser says, she checks to make sure there’s an up-to-date colonoscopy if they’re over 45 and does a transabdominal, transvaginal ultrasound to examine the reproductive organs.
“I remember feeling full quickly,” says Kimberly Singleton, who was diagnosed with ovarian cancer at age 32. “I always used to order this one salad out and could easily finish it, but suddenly I was only eating half of it.”
Ascites, the same fluid buildup that causes some ovarian cancer patients to feel bloated, may also result in a loss of appetite.
“There’s fluid in their abdomen, there are frequently lesions, you know, implant lesions all over their bowel, and something potentially pressing against their bladder,” says Dr. Brightman. As a result of eating less over time and feeling full sooner, women who experience increased satiety also notice weight loss.
In addition to increased satiety, the fluid buildup in the abdomen can also lead to indigestion.
Ashley had heartburn, while Alicia says she experienced gas for six months straight leading up to her ovarian cancer diagnosis. This is common among ovarian cancer patients, who tend to experience general discomfort in the abdomen, including bloating and constipation due to the placement of their tumors.“I was nearing my 50th birthday and I was feeling a lot of gas, but I chalked it up to eating a high-fiber diet or maybe just getting older,” says Alicia.
“In the very beginning it felt like I was having menstrual cramps,” recalls Sheryl. Since her cycle had always been accompanied by uncomfortable cramps, she didn’t think much of the discomfort at first.
It’s not uncommon for tumors growing in the pelvis to cause pain in the lower abdomen. And since the discomfort can feel similar to period cramps, many women assume the tummy troubles are benign. As Alicia Dellario, 54, tells Health, “It’s very easy to ignore the symptoms of ovarian cancer.”
Since half of women diagnosed with ovarian cancer are over the age of 63, and likely post-menopausal, cramping is another sign that doctors flag. “Especially in a post-menopausal woman, if there are menstrual signs like cramps or bleeding, though I’ve never really seen [bleeding], then we want to evaluate ASAP,” Dr. Brightman says.
“I came home from work one day in excruciating back pain,” remembers Sheryl. “I couldn’t sit, I couldn’t stand. It was constant.” The discomfort interfered with her sleep too: “The pain was so bad that it would wake me up in the night.”
Kimberly also experienced back pain: “Right before my diagnosis, I was having very bad lower back pain,” she says. “It was so severe that it was interrupting my day.” The ache was more intense than the back pain she typically experienced from sitting at her desk all day. “I had to take ibuprofen for it daily,” she says.
Women with ovarian cancer can experience back pain when fluid accumulates in the pelvis or when the tumor spreads in the abdomen or pelvis, directly irritating tissue in the lower back, says Marleen Meyers, MD, an oncologist at New York University’s Langone Medical Center.
“Because many of us get back pain at one time or another, the key is to report new pain that doesn’t go away,” says Dr. Meyers, “especially if it is not related to physical activity that may have strained your back.”
The urge to go
In the weeks leading up to her diagnosis, Kimberly felt like she had to urinate—constantly. “I would say every 30 minutes I would get the urge to go, but when I tried, nothing would come out or it would just be a trickle.”
Alicia also experienced an increased urge to urinate. She thought she had a UTI and even took two rounds of antibiotics to treat her symptoms. “I always had to go to the bathroom,” she says. “I tend to drink a lot of water, so I’m always going to the bathroom anyway, but this was escalated. I couldn’t even sit through meetings at work. It was embarrassing.”
Dr. Brightman says this symptom comes from “the cancer pressing near the ureters that bring the fluid from the kidneys into the bladder.”
“In my case it was that my period was coming every two weeks,” says Sheryl Newman, who was diagnosed with stage 4 ovarian cancer at age 53. “I’d already been through menopause and stopped getting my period for about nine months. So when it started up again, I knew something wasn’t right.”
Irregular bleeding is most common among women with ovarian stromal tumors (though Sheryl didn’t have them), which only account for 1% of all ovarian cancers. Stromal tumors often produce estrogen, which can cause period-like bleeding, even after menopause, according to the ACS.
Since the bleeding is only a symptom of 1% of ovarian cancer cases, Dr. Brightman says, it’s not high up on the list of symptoms to look out for.
“By the time I felt pressure in my lungs, I was already at stage 3 or 4,” says Sheryl. Though the discomfort would come and go, she remembers having difficulty breathing especially when she would lie down.
Late-stage ovarian cancer can bring on breathing troubles. As tumors grow large, they may begin to press against the lungs and obstruct a patient’s ability to inhale and exhale.
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