Ovarian cancer is the fifth most common form of cancer. Ovarian cancer signs can be very non-specific which can make diagnosing ovarian cancer more difficult. These signs may include:
Wind and Bloating
Altered bowel habit
Swelling of the abdomen
Symptoms of vaginal bleeding and discharge
Dyspareunia or pain during sex
As you can see, some of these ovarian cancer signs can be very similar to IBS or Irritable Bowel Syndrome. Diagnosing ovarian cancer in my gastroenterology clinic is not that uncommon as I'm often referred women with symptoms of wind, bloating and change in bowel habit.
Ovarian cancer normally occurs spontaneously, without any obvious cause. Some women are at increased risk and these include smokers, those with a family history (particularly if you are a carrier of the BRCA1 or BRCA2 mutation), obesity, over the age of 65 years and in those who have never been pregnant or taken the oral contraceptive pill.
The main ovarian cancer type is something called an epithelial tumour. These grow from the surface of the ovaries. There are other types of ovarian cancer including a germ cell tumour which grow from the egg-producing cells and stromal tumours, but both of these are rare and can occur in young age. Occasionally tumours from other areas of the body can spread to the ovaries and this is known as metastatic disease.
It is diagnosed by 4 different routes whether Ovarian cancer signs are present or not:
The first is the history. If there is a strong family history of ovarian cancer this will clearly alert your doctor as to the potential for the problem to be present. A family history of breast cancer will also alert your doctor as the BRCA1 and 2 mutations seen with breast cancer also increases risk for ovarian cancer.
I have already outlined the signs above and if you have any of these, your doctor will need to consider the diagnosis. However, I have already mentioned that these ovarian cancer signs can be very non-specific so it does make this more difficult. In a woman over the age of 65 years, these symptoms should always be investigated.
The second route of diagnosis is the examination. On clinical examination, your doctor may find nothing wrong. Sometimes a palpable lump or mass may be felt in the lower abdomen which will alert your doctor and require urgent investigation.
In the latter stages of the disease other features on examination may be found. These include ascites or fluid in the abdomen which in turn can cause bloating and sometimes difficulty breathing. The breathing difficulty is due to splinting of the diaphragm as the fluid accumulates in the abdomen. The fluid can also track in to the chest, classically in the left chest resulting in a pleural effusion. This can also occur through spread of the tumour in to the chest.
Other ovarian cancer signs on examination may include evidence of weight loss and enlarged lymph glands known as lymphadenopathy.
The 3rd route is through blood investigation which may show evidence of anaemia or what is known as end-organ dysfunction. For example if the tumour has spread to the liver, the liver function blood tests may be abnormal. If the bones are affected, anaemia may be an issue. If the kidneys have been affected, the renal blood tests maybe abnormal. There is also a ‘tumour marker’ blood test for ovarian cancer known as the CA125 or carbohydrate antigen. This needs to be interpreted with caution if raised as it can occur in benign conditions such as endometriosis and fibroids.
The 4th route in diagnosis is though radiological investigations. The first of these is usually an ultrasound examination similar to the scans you have when pregnant. This may be performed via the vagina as it is a better way of visualising the ovaries.
The other main radiological investigation in ovarian cancer diagnosis is a CT scan which can not only visualise the tumour, but also look for evidence of spread of tumour. A tissue biopsy may be taken using ultrasound or CT guidance to confirm the diagnosis. If ascites or fluid in the abdomen is present, a sample may be taken to look for abnormal cells.
Of course once ovarian cancer signs have been found and investigations completed, the main way to confirm the diagnosis and to treat the tumour is by surgically removing the tumour. This is usually by removal of the ovary containing the tumour, known as oophorectomy. Chemotherapy may also be required in helping to cure this particular cancer too.
In summary, ovarian cancer causes many non-specific symptoms and because of this it can often present quite late in the disease. If you are concerned that you may have some of the ovarian cancer signs, particularly if you are over the age of 65 years, you should seek urgent medical advice in this matter.