Updated on March 29, 2024.
Ovarian cancer is the fifth leading cause of cancer deaths in women, according to the National Cancer Institute (NCI). Yet screening tests have not been proven to lower the risk of death from the disease. That’s part of why education and awareness are critical ways you can help protect yourself.
Understanding ovarian cancer
Your ovaries lie deep within your pelvis, which makes disease detection tricky. And although routine pelvic exams include checking for anything that feels out of the ordinary, early-stage ovarian tumors easily escape detection because they’re difficult to feel during an exam. Ovarian cancer is considered to be “silent,” because symptoms tend to be either vague or nonexistent until the disease has spread.
According to the Centers for Disease Control and Prevention (CDC), the best way to detect ovarian cancer early is to know the signs and be aware of changes in your body. If you notice any changes that are unusual for you and that could be a symptom of the disease, it’s important to see your healthcare provider (HCP) and get checked for ovarian cancer.
If ovarian cancer is detected early before it has spread, the five-year survival rate (the percentage of people who are alive five years after being diagnosed with ovarian cancer) is about 92 percent, according to the NCI. Even if it has spread beyond the initial tumor but has not yet spread outside the pelvic area, the five-year survival rate is around 73 percent. Unfortunately, only 24 percent of cases of ovarian cancer are found in these early, more treatable stages. The vast majority of ovarian cancers are diagnosed when the cancer has spread to distant parts of the body, at which point the chances of survival are significantly reduced. About 31 percent of people diagnosed at this point survive more than five years after diagnosis.
Research is under way to develop new, more accurate methods of detecting ovarian cancer early.
Four important symptoms
The following four symptoms are the most common early warning signs of ovarian cancer, according to the American Cancer Society (ACS):
- Abdominal or pelvic pain
- Bloating or abdominal distension
- Early satiety (feeling full quickly) or difficulty eating
- Feeling an urgent need to urinate, or increased frequency or urination
Keep in mind that these are all common symptoms of other health conditions. If you experience some of these issues, it does not necessarily mean that you have ovarian cancer.
It’s important to note if these symptoms are new, persistent, unusual for you, happen more often, or are more intense than normal. The ACS recommends counting any occurrences of these symptoms. If they are new to you and happen more than 12 times a month, it’s time to see your HCP.
Additional symptoms associated with ovarian cancer can include:
- Abnormal vaginal bleeding
- Back pain
- An upset stomach (such as diarrhea and nausea)
- Fatigue
- Menstrual irregularity
- Painful intercourse
- Swelling of the abdomen with weight loss
A diagnosis of ovarian cancer is not made based on symptoms alone. But by defining symptoms and raising awareness, people with ovaries may be encouraged to listen more closely to their bodies and establish an ongoing communication with their HCPs.
Testing for ovarian cancer
The tests used most often to look for early ovarian cancer are done in addition to a manual pelvic exam (when your HCP inserts two gloved fingers into your vagina, then presses gently on your lower abodmen with the other hand to examine your pelvic organs). They are:
- A blood test that measures the level of cancer antigen 125 (CA-125), a protein produced by ovarian cancer cells
- A transvaginal ultrasound, an imaging exam that uses an instrument inserted into the vagina, and uses sound waves to view the organs in the pelvic area
Elevated levels of CA-125 could be a sign of ovarian cancer but may also be caused by something else, such as pelvic inflammatory disease (infection of the female reproductive organs) or endometriosis (when cells that line the inside of the uterus grow outside the uterus). What’s more, not everyone with ovarian cancer has high levels of CA-125.
A transvaginal ultrasound (TVS) can detect a mass in the ovary, but most of the time these masses are not cancer.
The two tests carry a lot of uncertainty, although a 2019 study published in Current Oncology Reports found that for some patients, tracking CA-125 over time (in combination with transvaginal ultrasound) detects more early-stage disease. They are not shown to reduce ovarian cancer deaths, however, and are not used for routine ovarian cancer screening.
Be your own advocate
Screening for ovarian cancer is not yet a routine part of preventive healthcare. But if you have concerning symptoms, in addition to some of the following risk factors identified by the CDC, make an appointment with your HCP right away:
- You’re middle-aged or older
- You have a family history of ovarian cancer in close family members on either side of your family
- You have a genetic mutation called breast cancer 1 gene (BRCA1) or breast cancer 2 gene (BRCA2), or one that is associated with Lynch syndrome (a hereditary condition that increases your risk for colorectal cancer and increases the risk for many other cancers)
- You’ve had colon, breast, or uterine cancer
- You have endometriosis
- You have an Eastern European or Ashkenazi Jewish background
- You’ve never given birth or have had trouble getting pregnant
- You’ve taken the hormone estrogen by itself for 10 or more years
Research shows that ovarian cancer may often originate in the fallopian tubes, which connect the ovaries to the uterus. If you will be undergoing tubal ligation (also called "getting your tubes tied," surgery to cut and seal the fallopian tubes to permanently prevent pregnancy) or are having another gynecologic surgical procedure, you may want to talk with your HCP about including a salpingectomy, or complete removal of the tubes, rather than simply tying them off. This procedure may lower your risk of ovarian cancer.
Don't ignore unusual or painful symptoms. And if you feel you're not being taken seriously or your care is not as thorough as you'd like, consider getting a second opinion.
The future of testing
Scientists are researching and developing ways of making ovarian cancer screening more accurate and sensitive, to improve earlier identification of ovarian cancer. Here are the main avenues of research:
Blood biomarkers are molecules found in blood that can indicate a health condition. They may be helpful in detecting early-stage ovarian cancer, both by themselves and together with CA-125. One biomarker in particular, a protein called human epididymis protein (HE4), when combined with CA-125 has been shown to significantly enhance the ability to figure out whether a mass is benign (not cancerous) or cancerous.
Autoantibodies are proteins made by our immune system that attack our own cells by mistake. They are stimulated when even small volumes of cancer are present, so they could be helpful indicators of cancer. Testing for panels or groups of autoantibodies is currently being looked at as a screening tool to complement CA-125 and transvaginal ultrasound.
MicroRNAs are molecules that float around in body fluids and change based on your state of health. Early research indicates they may be potential biomarkers.
Circulating tumor DNA (ctDNA) testing might also be a way of detecting tumors. However, this method can give false positives (a positive test result when disease is not actually present) and isn’t as helpful in the early days of the development of a cancer.
The genes of people with ovarian cancer have often undergone DNA hypermethylation, a process that cancer cells use to turn off genes that block the way of tumor development which can result in out-of-control growth of cancer cells. It seems that hypermethylation may be a good marker for cancer cells, and in one 2017 study published in Genome Medicine screening for it predicted cancer correctly in more than 50 percent of cases. If confirmed in larger studies, blood tests for DNA methylation-based screening may be useful in ovarian cancer diagnosis.
Since ovarian tumors can stay very small (less than three millimeters) for several years, they can be hard to see with transvaginal ultrasound. This is where other imaging technology might be able to help, such as magnetic resonance imaging (MRI, which uses radio waves to take images of the inside of the body). Experimental imaging techniques that could be used in diagnosing ovarian cancer include magnetic relaxometry (MRX), and superconducting quantum interference devices (SQUIDs). MRX and SQUIDS can detect magnetic nanoparticles, extremely small particles inside the body.
As diagnostic tools for early detection are further refined, you can increase awareness about this silent disease by learning to recognize possible symptoms, knowing your risk factors, and working with your HCP to understand the latest diagnostic methods that are available and appropriate for you. If you have questions about ovarian cancer and what diagnostic tests are covered by your insurance, speak with your HCP.
