Ovarian Cancer: Spot the 10 Warning Signs

Ovarian cancer is the fifth deadliest cancer among Malaysian women, after cervical cancer and lung cancer. About 80 percent of these ovarian cancer cases are diagnosed at later stages, mainly Stage 3. 

Known as the “silent killer”, ovarian cancer typically shows subtle symptoms in early stages. It often goes undetected until the tumour has spread widely and the symptoms become severe. 

4 Stages of Ovarian Cancer

Cancer staging is fundamental in determining the severity of a tumour. It serves as a guidance for healthcare professionals to infer appropriate prognosis, so they can provide the best treatment to suit each patient’s condition.  

The common staging system used for ovarian cancer is the International Federation of Gynaecology and Obstetrics (FIGO) system. When diagnosing the stages of ovarian cancer, the doctor will look into these three aspects:

• Has the tumour spread beyond the ovary or fallopian tube? 
• Has the tumour spread to nearby lymph nodes? 
• Has the tumour spread to other distant organs? 

On top of that, the five-year survival rate is also used for ovarian cancer prognosis. This does not mean the patient has only five years to live—it estimates how high the chances are to survive after five years from the first diagnosis. Survival rate is useful to monitor the progress of the tumour and the effectiveness of treatment. However, it is important to note that the percentage is only based on the general population, so it may not apply the same to each individual patient.

There are four major stages of ovarian cancer:

Stage 1

Stage 1 ovarian cancer is identified when the cancer is found in one or both of your ovaries, but still has not spread further. Many patients fail to get diagnosed in this early stage as they believe the symptoms will go away after a few days, thus only resorting to home remedies instead of going to the doctor. 

Generally, patients who manage to get detected at this stage are estimated to have over 90% chance of five-year survival. 

Stage 2

The ovarian cancer in Stage 2 has spread from one or both of the ovaries to the pelvic region (which include uterus, fallopian tubes, bladder, colon, and rectum). 

Very few patients are diagnosed with Stage 2 as symptoms usually overlap with Stage 3, where the cancer is already entering the abdominal area. 

For most patients of Stage 2 ovarian cancer, they may expect about a 70% rate of 5-year survival. 

Stage 3

Stage 3 has the highest number of cases where most women get diagnosed with ovarian cancer.

At this stage, the cancer has spread to the abdomen, and possibly the lymph nodes as well. 

The doctor may predict roughly 39% of the 5-year survival rate.  

Stage 4

Stage 4 is the most advanced and severe stage of ovarian cancer. 

It is also known as the metastatic stage, meaning the cancer has travelled further from the primary tumour in the ovary and spread to other organs, like lungs and liver, where it forms secondary tumour.  

Stage 4 predicts the lowest rate of 5-year survival at 17%.

Warning Signs of Ovarian Cancer

A critical problem when it comes to any type of cancer, including ovarian cancer, is late diagnosis. Many women often dismiss early symptoms, thinking they are mild. In reality, early signs of ovarian cancer develop slowly and silently, which makes it more dangerous. 

In this article, we will list out some of the warning signs of ovarian cancer, so you can be more alert when these symptoms occur to prevent further spread of the tumour. 

• Prolonged pain in the pelvis or abdomen

A major sign of ovarian cancer is feeling of discomfort in the pelvic or lower abdominal region. It happens when the growing tumour causes pressure that pushes against organs, nerves, or blood vessels in those areas resulting in pain and tension.   

A lot of women express the pain as being similar to period cramps—which is why many often think it is not a symptom of a serious disease like ovarian cancer, and decide not to go for a check-up. Regardless, do consult your doctor if you experience abnormal discomfort, especially if the pain does not go away. 

If you are already in the post-menopausal phase (usually age 50 and above) whereby you no longer undergo menstruation, having period-like cramps in the pelvis or abdomen is a huge red flag and should be rushed for medical evaluation. 

• Bloating 

Bloating is the uncomfortable feeling of tightness and fullness in your stomach, as if it is filled with a lot of air or gas. Aside from cramps, women also normally experience temporary bloating a few days before and during their menstrual period. However, if you continuously feel bloated for more than 2 weeks, that signals a bigger problem.

The bloating is caused by ascites, a condition where fluids build up in your abdomen. This can occur in several ways:

• Tumour spreads to the linings of the abdominal wall (peritoneum), causing an irritation. As a response, excess fluids are produced.
• Tumour spreads to the blood vessels of the liver, causing increased blood pressure due to constricted blood flow (known as portal hypertension). As a response, fluid can leak out of the blood vessels and accumulate in your stomach. 
• Tumour spread to the lymph nodes results in blockage, which prevents them from draining lymph fluids in your body tissues into the blood effectively. This causes the excess of fluid to collect in your stomach.

If abdominal swelling (distension) and heartburn accompany the bloating, you should immediately get those symptoms assessed. 

• Changes in appetite

As your stomach is already bloated with fluid build-up due to ascites, consuming food makes you feel full faster, even though you feel hungry before eating. This can happen even when you consume small portions and light meals.  

Bloating can also trigger nausea, causing you to lose appetite. 

• Frequent urge to pee

When ovarian cancer starts to grow around the surface of your bladder, it creates a pressure that makes you want to pee more often than usual. It may also result from the tumour pressing against the ureter, the tube carrying fluid from the kidney to your bladder.

A common bladder-related issue that may indicate a sign of ovarian cancer is having an increased urge to pee but when you rush to the toilet, only a small amount of pee or none comes out. Sometimes, you may feel like you cannot hold your bladder for too long (urgency) as well. 

If this condition lasts for several days and disrupts your daily life, it is best to visit the doctor’s office instantly. 

• Changes in bowel movement

Diarrhoea and severe constipation may also indicate a warning sign of ovarian cancer. 

As the tumour grows and lymph nodes become enlarged due to swelling, your intestines are getting pushed.This creates an obstruction to the flow of digestive system, trapping your digested food and bodily waste. Your stool may also come out thinner.

Disturbances in the bowels are more likely to occur at advanced stages. Hence, you should pay attention to any new changes in your bowel habits so that the symptoms will not progress to develop ovarian cancer. 

• Weight loss

Loss of appetite and eating less give rise to another health problem, which is weight loss. Weight loss that is not caused by changes in exercise routine or diet management, can be a worrying sign of ovarian cancer. 

Women who have reached the advanced stage of ovarian cancer may experience a syndrome called cancer cachexia. The symptoms include loss of muscle and bone mass, resulting in dramatic weight loss. This might be caused by the chemical reaction of your immune system to the cancer itself. 

• Extreme exhaustion

There are various factors that can contribute to exhaustion, like lack of sleep and stress. However, fatigue as a warning sign of ovarian cancer can be caused by the decrease in appetite. Not eating well leaves you feeling lethargic due to lack of nutrition and loss of energy. 

Another reason your body feels weak is due to the cancer itself. Having a tumour growing naturally activates your immune system. If the ovarian cancer is not detected early, this immune system will constantly use up your (already depleting) energy to fight against the cancer cells. As a result, you get tired easily and more frequently. 

It is important to check with your doctor if you experience prolonged and extreme tiredness, even after getting enough rest and making active changes to your lifestyle habits.

• Pain during sexual intercourse

Also known as dyspareunia, ovarian cancer can cause pain in the genital area during or after intercourse. 

Having sex can be painful when there is a tumour pressing against your vaginal area. Changes in hormones from the ovarian cancer also lead to vaginal dryness—lack of vaginal lubricant during sexual penetration contributes to discomfort for women. 

Painful sexual experience affects not only your overall health but also the intimacy with your partner. Seek medical advice from your doctor to find out if the pain is caused by ovarian cancer or other minor conditions. 

• Changes in menstrual period

Irregular periods are usually not a common sign of ovarian cancer, especially if that is a normal cycle for you—although, recent studies suggest that young women with irregular bleeding may have a higher risk of developing ovarian cancer as an adult. 

Arrange an appointment with your gynaecologist at once, if you encounter these sudden changes in your period such as:

• heavier bleeding
• increased period cramps
• missing or late periods
• having period more than once within a month

For post-menopausal women, vaginal bleeding without unknown reasons is not normal and should not be ignored. 

• Lower back and leg pain

Ovarian cancer does not directly cause lower back and leg pain. These are secondary pain extended from the abdominal cavity, when the tumour starts growing in the pelvis and abdomen. 

Fluid build-up can also lead to swelling in your leg including ankles, feet, thighs, and lower leg. 

If you experience pain in the lower back or legs due to undetermined reasons other than menstruation and heavy lifting, consult your healthcare provider to figure out the causes.  

When To See A Doctor

As we have learned, the warning signs of ovarian cancer are commonly mistaken for other conditions like ageing, menstruation, urinary tract infection, and indigestion. This makes early detection a complicated and confusing process.  

However, there are few important indicators that signal a need for prompt medical assessment :

• 2-week rule : Symptoms last beyond two weeks.
• Symptoms get worse. 
• Symptoms are caused by unknown reasons, or not due to other health conditions. 
• Symptoms would not go away after treating with over-the-counter and home treatments. 

Diagnosing ovarian cancer involves a series of tests that are time-consuming. Therefore, putting off visiting the doctor can lead to delayed diagnosis and late treatments, which can reduce your survival rate. 

Seek immediate medical help when there are abnormal changes in your body, while your health is still promising.

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