What are the symptoms of ovarian cancer?

Ovarian cancer symptoms can be easy to miss or attribute to common conditions like digestive issues or menstrual changes. Knowing what to watch for and when to seek medical attention can make a crucial difference in early detection, when treatment is most effective.

Step 1: Watch for Key Symptoms

If you’re experiencing any of these ovarian cancer symptoms persistently (occurring more than 12 times a month or consistently for 2+ weeks), schedule an appointment with your gynecologist immediately.

• Persistent bloating: Not occasional fullness after meals, but ongoing bloating that doesn’t go away and may worsen over time. Your clothes might feel tighter around the waist.
• Pelvic or abdominal pain: Can range from dull aches to more severe pain, similar to menstrual cramps but occurring outside your regular cycle.
• Feeling full quickly: Sudden inability to finish normal-sized meals or feeling uncomfortably full after just a few bites.
• Urinary changes: Increased urgency or frequency — finding yourself rushing to the bathroom more often without other explanation.
• Unusual fatigue: Feeling exhausted despite adequate rest, to the point where it interferes with daily activities.
• Back pain: Particularly lower back pain that’s new and persistent.
• Abnormal vaginal bleeding: Especially important for post-menopausal women to investigate promptly.

Major red flags that demand immediate attention:

• Postmenopausal vaginal bleeding
• Progressive worsening of any symptoms over time
• Increasing difficulty with bowel movements or urination
• Growing discomfort during sexual intercourse
• Unexplained weight loss combined with abdominal swelling

Trust your body. If something feels “off” or different from your normal, don’t ignore it.

Step 2: Advocate for Yourself

At the doctor, be your own advocate. Explain your symptoms in detail and directly express your concerns about ovarian cancer. Don’t accept dismissive responses if you feel something is wrong. Ask specifically for a referral to a gynecologic oncologist. Don’t settle for “watching and waiting” if your symptoms persist.

Understanding ovarian cancer testing:

• Transvaginal ultrasound: This creates images of your ovaries and uterus but can’t definitively determine if the masses are cancerous.
• CA-125 blood test: Measures a protein often elevated in ovarian cancer, but can also be elevated due to other conditions (endometriosis, fibroids, menstruation).
• Pelvic exam: Important but often not effective at detecting early-stage ovarian cancer.
• Imaging tests: CT scans, MRIs, and PET scans provide detailed views of your pelvic area.
• Newer tests: Some doctors may use multimarker tests like HE4, ROMA, or OVA1, which can be more accurate than CA-125 alone. (Read more about early detection and testing here.)

Important to know:

• Pap smears DO NOT detect ovarian cancer. They only screen for cervical cancer.
• No single test can reliably screen for ovarian cancer.
• A surgical biopsy remains the only definitive way to diagnose ovarian cancer.
• False negatives happen. About 20% of women with ovarian cancer have normal CA-125 levels.

Prepare for your appointment:

• Keep a detailed symptom diary with dates, duration, and severity
• List all medications and supplements you take
• Bring your complete family medical history, especially any cancer cases
• Write down specific questions and concerns beforehand
• Consider recording the appointment (with permission) to review later

Recently diagnosed with ovarian cancer?

Receiving an ovarian cancer diagnosis can feel overwhelming, but you don’t have to navigate this journey alone. With the right medical team, support network, and information, you can make empowered decisions about your care and take control of your path forward.

Step 1: Make Informed Decisions 

Take a deep breath. You’ve found us as a resource, and you’ve got this. A diagnosis is overwhelming, but remember that many women successfully navigate this journey.

First things to know:

• Your diagnosis is the beginning of a journey, not the end
• The decisions you make now can significantly impact your outcomes
• There are resources, specialists, and support systems ready to help you
• You have time to make informed decisions, so don’t rush this process

Step 2: Choose Your Medical Team

If ovarian cancer is suspected, insist on seeing a gynecologic oncologist, a specialist specifically trained in cancers of the female reproductive system.

Finding the right surgeon is important:

• Research gynecologic oncologists at specialized cancer centers
• Don’t hesitate to travel for the right specialist — this decision is critical
• Ask about their experience, specifically with ovarian cancer surgeries
• Always get a second opinion from another gynecologic oncologist before proceeding with treatment

Studies show that patients whose initial surgery is performed by a gynecologic oncologist have a 30% higher survival rate than those operated on by general surgeons or regular gynecologists. A second opinion can confirm your diagnosis and treatment plan or offer alternative approaches.

Before surgery:

• Ask about fertility preservation options if applicable
• Discuss the extent of the planned surgery and recovery expectations
• Bring someone to support you and help process complex information
• Request to freeze your tumor for future testing and analysis (note: this may incur additional costs not covered by insurance)

After diagnosis:

• Ask your doctor to test your tumor’s genetic makeup (Caris Life Sciences offers a commonly used test)
• Request comprehensive blood work to establish baselines before and after surgery (including CA-125 and tests like Signatura by Natera)
• Inquire about clinical trial eligibility — patients in trials often have better outcomes
• Connect with ovarian cancer support groups specific to your type.

Remember: Being proactive about your symptoms and advocating for thorough evaluation can literally save your life. With ovarian cancer, early detection and treatment by specialized professionals make a dramatic difference in treatment options and outcomes.

Step 3: Discuss Testing with Your Doctor

Request genetic and molecular testing of your cancer. These tests analyze your tumor’s specific characteristics to help doctors select the most effective treatments for your particular case.

Testing to discuss with your doctor:

• Tumor DNA testing to identify specific gene changes that can be targeted with specialized drugs
• Hereditary genetic testing to check for inherited mutations (like BRCA) that run in families
• Testing for DNA repair deficiencies that might make certain treatments more effective
• Testing to determine if newer immunotherapy treatments might work for your cancer
• Blood markers like CA-125 to help monitor your response to treatment
• Bone density (DXA) scans to check for early bone loss, especially important if your treatment might affect bone health
• P53 testing to help classify your cancer type (mutations are common in high-grade but rare in low-grade and borderline tumors)

Why this matters: Different types of ovarian cancer respond to different treatments. For example, low-grade serous ovarian cancer (LGSOC) responds poorly to standard chemotherapy but may benefit from targeted therapies like MEK inhibitors or hormone therapy.

Step 4: Ask About Clinical Trials Early in Your Journey

Patients enrolled in clinical trials often have better outcomes than those who receive standard care alone. Clinical trials offer access to cutting-edge treatments not yet widely available, and contrary to common belief, many trials are designed for newly diagnosed patients, not just those with recurrent disease.

Your gynecologic oncologist can help determine which trials might be suitable for your specific cancer type, stage, and treatment history. While you can research options on resources like ClinicalTrials.gov, always discuss potential trials with your healthcare team to ensure they’re appropriate for your situation. Not These Ovaries’ directory of the best ovarian cancer doctors will also feature clinical trial data. 

Step 5: Prepare for Treatment

Learn about your specific type of ovarian cancer and recommended treatment protocols.

There are over 30 kinds of ovarian cancer, each requiring a unique approach. For common high-grade serous ovarian cancer, standard treatment typically includes debulking surgery and platinum-based chemotherapy, often followed by maintenance therapy with PARP inhibitors, especially for those with BRCA mutations. However, low-grade serous ovarian cancer and borderline ovarian tumors require different treatment approaches:

• High-grade serous cancer typically responds to standard chemotherapy
• Low-grade serous cancer (LGSOC) and borderline tumors (BOT) affect younger women and require specialized treatment strategies
• These less common types may need targeted therapies instead of standard chemotherapy
• Always get a second opinion from a gynecologic oncologist experienced with these specific subtypes

Prepare for potential treatment side effects. All cancer treatments can cause side effects, but many can be managed effectively with proper planning and support. Ask your medical team about the common side effects of your specific treatment plan and what proactive steps you can take to minimize their impact on your quality of life.

Examples include cold capping during chemotherapy to reduce hair loss, anti-nausea medications that can be taken before symptoms appear, hydration strategies to protect kidney function, and exercise programs that help maintain strength and energy during treatment. Being prepared with the information can help you feel more in control of your cancer journey.

Step 6: Build Your Support Network

A comprehensive support system is essential for navigating both the emotional and practical challenges of treatment.

Critical support resources:

• Mental health professionals who specialize in cancer patients
• Support groups specific to ovarian cancer or your specific subtype
• Financial counselors to help navigate insurance and treatment costs
• Palliative care specialists who can help manage symptoms and improve quality of life
• Social workers who can connect you with community resources

Remember: Support isn’t just for emotional well-being — it can help you make better treatment decisions and may even impact survival outcomes.

Step 7: Know Your Fertility Preservation Options

Many ovarian cancer diagnoses, especially low-grade serous and borderline types, require the surgical removal of one or both ovaries.

Options to discuss with fertility specialists:

• Egg freezing before treatment if one ovary can be preserved
• Embryo freezing if you have a partner or donor sperm
• Ovarian tissue freezing in certain cases
• Surrogacy or adoption as alternative family-building options

Important: This conversation should happen BEFORE surgery whenever possible, as options become more limited afterward.

Step 8: Prepare for Potential Menopause

Many treatments can trigger immediate menopause, which brings both short and long-term health considerations.

Menopause can cause symptoms like:

• Hot flashes and night sweats
• Bone density loss (osteopenia and osteoporosis)
• Cognitive changes and memory issues
• Muscle pain and joint discomfort
• Vaginal dryness and sexual changes
• Mood fluctuations and emotional changes
• Increased risk of heart disease and high cholesterol

Proactive management strategies:

• Daily calcium (1200mg) and vitamin D (800-1000 IU) supplements
• Regular weight-bearing exercise to maintain bone density
• Reduced alcohol and caffeine intake
• Discuss non-hormonal options for symptom management with your doctor
• Bone density screening and cardiovascular risk assessment

Step 9: Continue to Advocate for Yourself

Your active participation in treatment decisions can significantly impact your outcomes. Effective self-advocacy includes:

• Keeping a symptom journal to track how you’re feeling
• Preparing questions before appointments
• Bringing a support person to important discussions
• Getting copies of all test results and surgical reports
• Understanding the goals of each treatment
• Asking about quality of life considerations for each option
• Seeking additional opinions when necessary
• Trusting your instincts if something doesn’t feel right

Remember: You are strong and capable, and you’re not alone on this journey. Every woman’s experience with ovarian cancer is unique, and the right treatment plan should be tailored to your specific situation, values, and goals.

Step 10: Consider Physical and Pelvic Floor Therapy

After ovarian cancer treatment, many women experience changes in their pelvic floor muscles and overall physical function. Both general physical therapy and specialized pelvic floor therapy can help address these issues and support your return to activity.

What to know: The timing for beginning physical therapy and pelvic floor therapy should be individualized based on your specific situation and recovery progress. Your healthcare team will recommend when it’s appropriate for you to start, which typically occurs after sufficient post-surgical healing.

A specialized therapist can address post-surgical issues like scar tissue, muscle weakness, and limited mobility, helping improve bladder/bowel function, reduce discomfort, and restore strength. Regular physical activity has been shown to improve quality of life and may be associated with better outcomes in ovarian cancer patients. Ask your oncology team to recommend therapists experienced in treating cancer patients.

Step 11: Understand Changes to Intimacy and Relationships

Ovarian cancer treatment can significantly impact your intimate relationships and sexuality. Understanding and addressing these changes can improve your quality of life during and after treatment.

• Physical changes may include vaginal dryness, sensitivity, and early menopause symptoms
• Emotional aspects like changed body image, confidence, and fatigue can affect desire
• Surgical recovery typically requires waiting at least several weeks or in some cases many months before resuming sexual activity
• If you’re having chemotherapy, using barrier methods like condoms is recommended

Discuss these concerns with your healthcare team, who can recommend resources like lubricants, sexual health specialists, and support groups. Whether you’re in a relationship or dating, open communication about your needs and feelings is key to navigating this aspect of your recovery journey.

What are borderline serous & low-grade serous ovarian cancers?

While high-grade serous ovarian cancer gets most of the attention, borderline and low-grade serous cancers are distinct conditions that behave differently and affect younger women. Understanding these less common but important subtypes is crucial for proper diagnosis, treatment decisions, and long-term care planning.

Borderline ovarian tumors (BOT) 

BOTs occupy a unique position between benign and cancerous tumors. They show abnormal cell growth but typically don’t invade surrounding tissues. These rare tumors affect about 5 in 100,000 women annually and are generally associated with a better prognosis than invasive cancers.

Low-grade serous ovarian cancer (LGSOC)

LGSOC is a rare subtype accounting for less than 10% of all ovarian cancers. It’s characterized by slow growth and cells that resemble normal tissue more closely than high-grade cancers do, which can make early detection challenging.

Key differences from high-grade serous cancer:

• Both BOT and LGSOC primarily affect younger women 
• They grow more slowly but can be just as invasive in later stages
• They respond differently to treatment (standard chemotherapy is less effective for these types)
• LGSOC has a higher recurrence rate (over 70% of advanced cases), though recurrences often grow slowly

Treatment approaches

For low-grade serous ovarian cancer (affecting younger women, average age 45):

• Surgery is critical, as chemotherapy has limited effectiveness
• Hormone therapy and targeted treatments like MEK inhibitors show more promise
• This type grows more slowly but has a high recurrence rate (70%)

For borderline ovarian tumors:

• Surgery is the primary treatment; chemotherapy is NOT recommended
• Often affects younger women (ages 20-50)
• Get a second pathology opinion, as these are sometimes misdiagnosed

Long-term considerations

Both borderline and low-grade serous conditions often raise important fertility considerations, as treatment may involve removing reproductive organs. 

Regular follow-up is essential since recurrence can happen years after initial treatment, with at least a 30% risk for advanced-stage borderline tumors with invasive implants.

The rarity of these cancers makes specialist care critical. Consulting with a gynecologic oncologist who has experience with these specific subtypes can significantly impact your treatment outcomes and quality of life. 

Meanwhile, ongoing research continues to explore better treatments for these understudied cancer types, offering hope for improved options in the future.