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Subtle signs of ovarian cancer women should look out for

Washington University School of Medicine
Andrea Hagemann, MD, and resident Lulu Yu, MD, perform a bilateral salpingo-oophorectomy because of a BRCA2 gene mutation. Andrea Hagemann, MD, and resident Lulu Yu, MD, perform a bilateral salpingo-oophorectomy because of a BRCA2 gene mutation.

The first symptoms of ovarian cancer are easy to miss, which is why it has long been called the “silent killer.” But ovarian cancer isn’t really a silent killer; the early signs are often ignored or mistaken for other benign conditions. Gynecologic symptoms for cervical, uterine and ovarian cancers are all easy to brush off, but being able to identify early symptoms is crucial. While uterine cancer rates have recently climbed past ovarian cancer’s, it remains a gynecological cancer needing special attention. Spotting the signs of ovarian cancer earlier means catching the cancer when it’s easier to treat.

What is ovarian cancer? Who does it affect?

Ovarian cancer is an overgrowth of abnormal cells that start in the ovaries, fallopian tubes or peritoneum. According to the American Cancer Society (ACS), ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. While this statistic may seem daunting, ovarian cancer rates have been slowly falling over the past 20 years.

This cancer is more common among white woman than Black women. It also primarily affects older women who have already gone through menopause. In fact, about half of women diagnosed with ovarian cancer are age 63 or older.

Types of ovarian cancer

There are three types of ovarian cancer. The type of cancer you have – and the best course of treatment for you – will depend on the type of cell where the cancer begins.

  • Epithelial ovarian cancer: this is the most common type of ovarian cancer. It develops in the tissue surrounding the ovaries.
  • Stromal tumors: these rare tumors form in the ovaries’ structural connective tissue cells that produce estrogen and progesterone.
  • Germ cell tumors: these rare tumors begin in the ovarian cells that develop into eggs.

Wondering if you might have ovarian cancer? You’re not alone.

If you are concerned that you might have ovarian cancer, you may have fears about fertility; relationships and sexual health; the physical, emotional and financial impacts of treatment; and death.

While your fears and concerns are entirely valid, it’s important to keep in mind that many women with ovarian cancer go on to lead full lives. Being able to spot the subtle signs of ovarian cancer ultimately gives you the best chances for a positive outcome.

Signs of ovarian cancer

Symptoms of ovarian cancer include:

  • Bloating
  • Abdominal discomfort or back pain
  • Pelvic pain
  • Irregular bleeding
  • Change in bowel or bladder habits
  • Feeling full too quickly or lack of appetite

Risk factors for ovarian cancer

Certain factors may increase a woman’s risk of ovarian cancer. These include:

  • Getting older. Generally, most ovarian cancers develop after menopause.
  • Being overweight or obese. Obesity raises the risk of ovarian cancer. It may also have a negative impact on the overall survival of women with ovarian cancer.
  • Having children later or never having a full-term pregnancy. Women who have their first full-term pregnancy after age 35 or who have never had a full-term pregnancy are at higher risk for ovarian cancer.
  • Undergoing hormone therapy after menopause. Women who take estrogen alone or with progesterone are at higher risk for ovarian cancer than women who have never taken hormones.
  • Having a family history of ovarian, breast or colorectal cancer. Ovarian cancer runs in families. Additionally, due to gene mutations, a family history of breast or colorectal cancer increases a woman’s risk for ovarian cancer. Genes linked to hereditary ovarian cancer include ATM, BRCA1, BRCA2, BRIP1, RAD51D, PALB2, MLH1, MSH2, MSH6 and PMS2.
  • Having a family cancer syndrome. According to the ACS, up to 25 percent of ovarian cancers are a part of family cancer syndromes caused by inherited gene mutations.

Types of family cancer syndromes

    • Hereditary breast and ovarian cancer syndrome (HBOC). This syndrome results from inherited mutations in the genes BRCA1 and BRCA2. Mutations in these genes are responsible for most inherited ovarian cancers. BRCA1 and BRCA2 gene mutations are about 10 times more common in women of Ashkenazi Jewish descent.
    • Hereditary nonpolyposis colon cancer (HNPCC)/ Lynch syndrome. The lifetime risk of ovarian cancer in women with this syndrome is up to 10 percent. In addition, up to one percent of all ovarian epithelial cancers occur in women with HNPCC.
    • Peutz-Jeghers syndrome. This rare genetic syndrome causes polyps to form in the stomach and intestine during adolescence. It is linked to a high risk of cancers of the digestive tract. Women with this syndrome are at increased risk for both epithelial ovarian cancer and a type of stromal tumor called sex cord tumor with annular tubules (SCTAT).
    • MUTYH-associated polyposis. This syndrome causes polyps to form in the colon and small intestine. People with this syndrome are at high risk for colon cancer. They are also more likely to develop cancers of the ovary and bladder.

When should I talk to my doctor?

Symptoms of ovarian cancer can be mild and may be confused with other issues. Just because you’re experiencing one or more symptoms doesn’t mean that you have ovarian cancer. Still, if your symptoms last three weeks or longer, you should make an appointment with your provider.

What will happen at my initial doctor’s visit?

First, your provider (typically a gynecologist) will perform a pelvic exam. They will also ask questions about your medical and family history.

Next, your provider may use one or more of the following tests to screen for ovarian cancer:

  • Ultrasound. This test uses sound waves to create pictures of structures inside the body. Your provider will be able to see if either ovary looks abnormal. If something abnormal is found, further testing will be recommended.
  • CA-125 blood test. This test looks for CA-125, a protein that may be found at higher levels in women with ovarian cancer. However, just because a woman has a high CA-125 level does not mean she has ovarian cancer. Many other conditions can raise CA-125 levels, such as pregnancy and liver problems.
  • Surgery. In some cases, an ovary will need to be surgically removed and tested for signs of cancer to confirm a diagnosis.
  • Genetic testing. Your provider may recommend testing a sample of your blood to look for gene mutations that increase ovarian cancer risk. Knowing you have an inherited gene mutation will help your provider when putting together your treatment plan.

The Siteman approach to ovarian cancer

Our nationally renowned gynecologic oncology program is the largest in the Midwest. With expert physicians, nurses, skilled support staff and the latest technology, we ensure that our ovarian cancer patients receive the comprehensive care they need. Our physicians are also actively involved in clinical trials that investigate new therapy approaches. Patients who undergo ovarian cancer treatment at Siteman have access to new therapies that are as good as – or even better than – current standard therapies available at other cancer centers.

In addition, Siteman Cancer Center and Washington University School of Medicine offer the latest fertility preservation treatments for women undergoing ovarian cancer treatment.

Our ovarian cancer specialists

The ovarian cancer specialist team at Siteman comprises outstanding Washington University gynecologic oncologists, radiologists, genetic counselors, psychologists, pathologists and nurses. The diverse expertise of our specialists allows them to create personalized treatment plans for all ovarian cancer patients.

Be your own ovarian cancer care advocate

If you are experiencing any early symptoms of ovarian cancer, don’t brush them off. While other conditions could be causing them, it’s important to rule out the possibility of ovarian cancer. Being aware of these subtle signs and understanding your own individual risk increases your chances of catching ovarian cancer early, when it’s easier to treat.

You’ve been diagnosed with ovarian cancer. Now what?

If you have received an ovarian cancer diagnosis, you may be feeling a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms of ovarian cancer, or if you have received an ovarian cancer diagnosis and would like a second opinion from an ovarian cancer specialist at Siteman, please call 800-600-3606.