Ovarian cancer is not a silent killer: recognizing its symptoms could reduce late detection

Ovarian cancer is the deadliest of gynecological tumors. Less than 40% of people diagnosed with ovarian cancer are cured, and approximately 12,810 women in the United States and 1,900 in Spain die each year from this disease.

For the past 25 years, scientists have been trying to find a screening test to detect ovarian cancer at its earliest stages, when the chances of a cure are high.

Unfortunately, multiple clinical trials with hundreds of thousands of participants have failed to identify an effective way to screen for ovarian cancer.

In fact, the US Preventive Services Task Force gave ovarian cancer screening a D rating in 2018, meaning it discourages regular screening because it doesn’t improve survival and can be harmful to patients.

Since there is currently no effective screening test, 70% of people with ovarian cancer are diagnosed in advanced stages, when the chances of cure are slim. Between 60% and 90% of people with stage one or two cancer, which remains in the ovaries and pelvis, are free of the disease five years after diagnosis.

But even those with advanced disease have a better chance of being cured if complete surgical removal is still possible. This makes early diagnosis even more important for overall survival.

Without screening tests, many doctors mistakenly assume that early diagnosis of ovarian cancer is not possible. As a gynecologic oncologist who treats hundreds of ovarian cancer patients each year, I was frustrated by these late diagnoses, wondering if better recognition of their symptoms could help doctors and patients identify ovarian cancer sooner.

detectable symptoms

Ovarian cancer has historically been called the “silent killer” because doctors thought its symptoms were undetectable. Patients were often diagnosed so late that doctors thought nothing could be done.

But in the last 20 years there have been many studies showing that ovarian cancer has early warning signs. My colleagues and I conducted one of the first studies in 2000. Our survey of 1,700 women with ovarian cancer found that 95% of patients reported noticeable symptoms three to twelve months before diagnosis. The most common symptoms were pelvic and abdominal pain, increased frequency and urge to urinate, difficulty eating or feeling full quickly, and bloating or bloating.

Importantly, people with both advanced and early-stage disease reported similar symptoms. Subsequent studies by numerous researchers further confirm that patients with ovarian cancer, even in the early stages, experience frequent symptoms.

We also found that ovarian cancer is often misdiagnosed as another disease. When we asked patients what their doctors said was the cause of their symptoms, 15% attributed them to irritable bowel disease, 12% to stress, 9% to gastritis, 6% to constipation, 6% to depression and 4% to some other cause. 30% received treatment for a different disease. And 13% were told that nothing was wrong.

One of the main problems has been distinguishing the symptoms of ovarian cancer from those of common gastrointestinal and urinary conditions. In another study, my team and I found that ovarian cancer patients have new-onset symptoms occurring more than 50% of the month.

To facilitate early detection of ovarian cancer, my team and I compared the symptoms experienced by ovarian cancer patients with those of patients without ovarian cancer. We developed an index that identified six major symptoms of ovarian cancer: bloating, enlarged abdomen, feeling full quickly, difficulty eating, pelvic pain, and abdominal pain. The symptoms had to occur more than 12 times a month, but had to last less than a year.

Based on these criteria, our index was able to detect ovarian cancer in 60% to 85% of patients in our study, a range similar to that achieved by diagnostic blood tests for ovarian cancer.

Recognizing the symptoms of ovarian cancer could lead to an earlier diagnosis.
FatCamera/E+ via Getty Images

Ovarian Cancer Prevention

Although early detection is important, there are also prevention strategies that can help reduce the risk of developing ovarian cancer.

If you have a family history of ovarian cancer, tell your doctor, who may recommend genetic testing to fully determine your risk, or prophylactic surgery to prevent the cancer from developing.

Oral contraceptives, tubal ligation (or surgery to close the fallopian tubes), pregnancy, and breastfeeding reduce the risk of ovarian cancer.

Finally, up to 70% of ovarian cancers can arise from the fallopian tubes. Removing the fallopian tubes at the time of another surgery may be another option to help reduce the risk of ovarian cancer. This should be done only if you are not planning to become pregnant in the future.

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