Kenneth R. Hirsch
Ovarian cancer, which begins in the ovary, is not as common as some other forms of cancer in women or men. Most cases of ovarian cancer are diagnosed at an advanced stage of the disease because it is difficult for women to recognize a cluster of typical but nonspecific symptoms as possibly indicating ovarian cancer rather than something like a digestive tract problem. Often when ovarian cancer is found, the tumor is no longer limited to the ovary, and symptoms are severe.
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Increased Abdominal Size and Feeling Bloated
Swelling of the abdomen is the most common symptom in women with ovarian cancer. Bloating is caused by a buildup of fluid, called ascites, which is thought to be related to obstruction of lymphatic drainage by cancer cells. More than 50 percent of women with late-stage ovarian cancer have ascites, according to an article in the May 2007 issue of "Annals of Oncology." The amount of fluid present can be large enough to produce weight gain and a notable increase in abdominal circumference. Cancer cells shed by the tumor float in the ascites, and the volume of fluid may become so uncomfortable that a doctor needs to drain it from the abdomen in a procedure called paracentesis. Typically, paracentesis is repeated at least once over the course of the disease.
Pelvic and Abdominal Pain
Women with late ovarian cancer are significantly more likely to report pain in the pelvic region, abdomen or both. The pain may have multiple causes. Ascites can cause abdominal or pelvic pain. A solid tumor mass may produce a lump that can be felt in the abdomen. According to an article in the August 2009 issue of “Gynecologic Oncology,” about 15 percent of women with late ovarian cancer are able to feel the tumor in the abdomen, and at least 35 percent report that the abdomen feels distended and hard. Late ovarian cancer extends from the pelvis to the reproductive organs and large intestine. Tumor involvement in the omentum, a layer of fat protecting various organs in the pelvic region, is common. Infiltration of the omentum and surrounding structures such as the stomach is a source of significant abdominal pain in women with late ovarian cancer.
Additional symptoms that are associated significantly with both early and late stages of ovarian cancer include lack of appetite or nausea, fatigue, frequent urination and constipation. Difficulty eating, such as a feeling of being full before a meal, is the most important of these symptoms, as it has been significantly associated with the presence of ovarian cancer. A case-control study published in the August 2009 issue of “Gynecologic Oncology” reported an association between abnormal vaginal bleeding -- not associated with menstruation -- and ovarian cancer. However, the American Cancer Society “Cancer Facts and Figures 2013” reports that abnormal vaginal bleeding is a rare symptom in women with ovarian cancer, although it is typical in other types of cancer.
Symptoms That Should Prompt Evaluation
Because of the late stage at which it is usually diagnosed, ovarian cancer treatment success has been historically lower than that for other cancers. Recent analysis indicates that a constellation of symptoms is experienced by women with late ovarian cancer: pelvic and abdominal bloating and pain, digestive symptoms involving difficulty eating and frequent urination. According to an article published in the January 2007 issue of "Cancer," when these symptoms begin within the year and occur more than 12 days per month, there is reason to suspect ovarian cancer and seek the advice of a doctor.