Ovarian Cancer
Ovarian cancer often progresses with mild, non-specific symptoms that resemble gastrointestinal or urinary complaints. Early evaluation by a gynecologic oncologist, especially when symptoms persist or recur, is crucial for diagnosis and proper treatment planning.
Symptoms of ovarian cancer
Early signs may be subtle. No single symptom proves ovarian cancer by itself, but the combination of persistence, frequency and change from a woman's usual pattern requires gynecological evaluation.
- Persistent bloating or abdominal distension that does not resolve.
- Pain or pressure in the lower abdomen and pelvis.
- Early satiety, reduced appetite or unexplained weight loss.
- Changes in bowel habits, constipation, gas or gastrointestinal discomfort without clear cause.
- Frequent urination, urgency or pressure on the bladder.
- Increased abdominal girth, ascites or feeling that clothes are tighter around the waist.
- Fatigue, nausea, back pain or pain during intercourse in some cases.
When urgent evaluation is needed
Ovarian cancer symptoms are often attributed to bowel issues, stress or hormonal changes. However, when they occur almost daily, persist for weeks or are new for the woman, they should not be ignored.
- Bloating, abdominal pain or early satiety lasting more than 2-3 weeks.
- New symptoms after menopause, even if they seem mild.
- Palpable mass, increased abdominal girth or suspicious finding on ultrasound.
- Family history of ovarian, breast, pancreatic or prostate cancer, especially at a young age.
- Known BRCA1, BRCA2, Lynch mutation or other hereditary predisposition syndrome.
Risk factors and heredity
Ovarian cancer risk increases with age, but personal and family history also play an important role. A proportion of cases are related to hereditary mutations, which is why a detailed history is part of the medical evaluation.
- Postmenopausal age, although this does not exclude occurrence in younger women.
- Family history of ovarian or breast cancer in first-degree relatives.
- BRCA1/BRCA2 mutations or Lynch syndrome.
- Endometriosis, which is associated with certain histological types of ovarian cancer.
- Obesity, menopausal hormone therapy and personal history of certain neoplasms.
- Nulliparity or limited number of pregnancies, assessed as part of the overall history.
Diagnosis of ovarian cancer
Diagnosis is based on a combination of history, gynecological examination, imaging and blood markers. CA-125 and ultrasound help assess risk, but definitive diagnosis is made by histological examination of tissue.
- Gynecological examination: Assessment of uterus, ovaries, pelvis and any mass or tenderness.
- Transvaginal and abdominal ultrasound: Evaluates size, morphology, septations, solid areas and vascularity of any mass.
- CA-125: A blood marker that may be elevated in ovarian cancer, but also in benign conditions like endometriosis or inflammation.
- HE4 and risk algorithms: May help in selected cases, always together with clinical picture and ultrasound.
- CT or MRI: Used for disease mapping and preoperative planning.
- Histological examination: Confirms tumor type and guides treatment.
Staging and preoperative planning
If malignancy is strongly suspected, the goal is not simply to remove a cyst but to plan oncologically correct management. Staging shows whether the disease is confined to the ovaries or has spread to the abdomen, lymph nodes or other organs.
- CT of the upper and lower abdomen and chest to assess peritoneal disease, lymph nodes, liver, lungs and ascites.
- Pelvic MRI when more detailed local imaging is needed.
- Assessment of general condition, nutrition, anemia and renal/hepatic function before surgery or chemotherapy.
- Discussion in a gynecologic oncology tumor board to choose between primary surgery or initial chemotherapy.
What a suspicious ovarian cyst or mass means
Most ovarian cysts are benign, especially in women of reproductive age. However, certain features require specialized evaluation to avoid either a delay in diagnosis or an inadequate procedure.
- Solid elements, papillary projections, thick septations or increased vascularity on ultrasound.
- Large size or increase in size on sequential examinations.
- Ascites or suspicious findings outside the ovary.
- Elevated CA-125 in a postmenopausal woman or with suspicious imaging.
- A mass combined with persistent symptoms such as bloating, pain, anorexia or frequent urination.
Treatment of ovarian cancer
Treatment is individualized based on stage, histological type, feasibility of complete surgical resection, the patient's general condition and molecular characteristics of the tumor. A combination of surgery and systemic therapy is usually required.
- Surgical staging: In early disease, includes removal of the tumor and assessment of the abdomen, omentum, peritoneum and lymph nodes where indicated.
- Cytoreductive surgery: In advanced disease, the goal is complete removal of all visible disease when feasible and safe.
- Platinum and taxane chemotherapy: A mainstay of treatment before or after surgery, depending on stage and resectability.
- Neoadjuvant chemotherapy: Chosen for certain patients when immediate complete surgical resection is not feasible or is too burdensome.
- Targeted therapies: Bevacizumab or PARP inhibitors may be used in selected patients depending on stage, response and molecular findings.
- Molecular and genetic testing: BRCA1/BRCA2 and HRD status help guide maintenance therapy with PARP inhibitors and inform family members when hereditary predisposition exists.
Follow-up after treatment and recurrence
After completion of treatment, organized follow-up is required. The goal is early detection of recurrence, management of complications and support for the woman on a physical and psychological level.
- Regular visits with history, clinical examination and assessment of new symptoms.
- CA-125 or other markers if they were elevated at diagnosis and are useful for monitoring.
- Imaging when clinically indicated, marker elevation or suspicious symptom.
- In recurrence, options such as new chemotherapy, targeted therapy or surgical reassessment are decided individually.
- Support for nutrition, fatigue, neuropathy, menopause, sexual health and psychological burden.
Fertility preservation and special cases
In younger women with very early disease or rare tumor types, conservative management may be discussed. The decision is made only after accurate staging and clear information about oncological safety margins.
- Preservation of the uterus and one ovary may be considered in strictly selected cases of early disease.
- Germ cell tumors and certain borderline tumors have different biology and often a different strategy from epithelial ovarian cancer.
- Egg or embryo freezing is discussed when time allows and the treatment strategy permits.
- Oncological safety always comes first, with a parallel effort to protect quality of life.
Symptoms
Early signs may be subtle. No single symptom proves ovarian cancer by itself, but the combination of persistence, frequency and change from a woman's usual pattern requires gynecological evaluation.
- Persistent bloating or abdominal distension that does not resolve.
- Pain or pressure in the lower abdomen and pelvis.
- Early satiety, reduced appetite or unexplained weight loss.
- Changes in bowel habits, constipation, gas or gastrointestinal discomfort without clear cause.
- Frequent urination, urgency or pressure on the bladder.
- Increased abdominal girth, ascites or feeling that clothes are tighter around the waist.
- Fatigue, nausea, back pain or pain during intercourse in some cases.
Ovarian cancer symptoms are often attributed to bowel issues, stress or hormonal changes. However, when they occur almost daily, persist for weeks or are new for the woman, they should not be ignored.
- Bloating, abdominal pain or early satiety lasting more than 2-3 weeks.
- New symptoms after menopause, even if they seem mild.
- Palpable mass, increased abdominal girth or suspicious finding on ultrasound.
- Family history of ovarian, breast, pancreatic or prostate cancer, especially at a young age.
- Known BRCA1, BRCA2, Lynch mutation or other hereditary predisposition syndrome.
Ovarian cancer risk increases with age, but personal and family history also play an important role. A proportion of cases are related to hereditary mutations, which is why a detailed history is part of the medical evaluation.
- Postmenopausal age, although this does not exclude occurrence in younger women.
- Family history of ovarian or breast cancer in first-degree relatives.
- BRCA1/BRCA2 mutations or Lynch syndrome.
- Endometriosis, which is associated with certain histological types of ovarian cancer.
- Obesity, menopausal hormone therapy and personal history of certain neoplasms.
- Nulliparity or limited number of pregnancies, assessed as part of the overall history.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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