Ovarian cancer is the most common cause of death in the U.S. from a gynecologic cancer, and is the fifth most common cancer death overall in women.

Tragically, it is often called a silent killer, as it is frequently asymptomatic until it spreads outside of the pelvic cavity. Many other common cancers, such as breast cancer and colorectal cancer, have accepted screening methods that have dramatically reduced deaths in recent decades.

In contrast, screening for ovarian cancer has been controversial for many years. Simple and inexpensive tests, such as pelvic exam by a physician and the Pap smear, do not adequately detect ovarian cancers in early stages. Tests such as abdominal ultrasound can detect ovarian cancers, but these are invasive and expensive.

Currently, neither the American Cancer Society nor the Public Health Service recommends ovarian cancer screening for the general population. For diagnosis, patients and clinicians rely on the signs and symptoms described here.

Common Signs and Symptoms

Ovarian cancer spreads first by local shedding of cancer cells into the peritoneal cavity, followed by implantation of tumor onto the peritoneum and pelvic organs such as the uterus, then via local invasion into the bladder and bowel. This progressive increase in pelvic tumor burden leads to the following common signs and symptoms:

• Abdominal or pelvic pain
• Bloating
• Difficulty eating or feeling full quickly
• Urinary urgency or frequency

Unfortunately, these more common signs and symptoms of ovarian cancer are fairly non-specific and may be as a result of a variety of conditions. However, their presence suggests ovarian cancer, and appropriate work-up should be done in any woman presenting with these complaints.

Other Signs & Symptoms

• Fatigue
• Nausea/vomiting
• Development of ascites (fluid in the abdominal cavity)

Note that ovarian cancer generally does NOT cause vaginal bleeding, as endometrial and cervical cancer often do.

Associated Disorders

Paraneoplastic syndromes, conditions caused as a result of a tumor, are common in many types of cancers, particularly lung cancer. Examples of paraneoplastic syndromes include hypercalcemia, myasthenia gravis, and Trousseauís syndrome (increased risk of blood clots in the lungs).

Ovarian cancer very rarely causes these types of disorders. Other types of complications from cancer often result from the location of the tumor mass.

For example, a lung cancer that has spread to the vertebrae of the spine may cause spinal cord compression. Ovarian cancer very commonly is confined to the abdomen and pelvis. As such, the most common associated disorders are due to infiltration of the kidneys, bladder, and intestines, causing renal failure and small bowel obstructions. Surgical resection is the primary management technique for these types of complications.