Ovarian Cancer: Understanding the Symptoms, Screening, and Treatment

Ovarian cancer has earned a difficult reputation not because it’s impossible to treat, but because it’s so often found late. Most women who are diagnosed with it had symptoms for months before seeking help. Not because they ignored them, but because the symptoms looked like something far more ordinary. Bloating. A feeling of fullness. Some back pain. Needing to urinate more often.

These are the kinds of symptoms people live with for months, assuming it’s IBS, stress, or just “getting older.”

Understanding what ovarian cancer actually looks like and knowing who needs to be watched more closely is what changes outcomes in this disease.

What is Ovarian Cancer?

Ovarian cancer develops when abnormal cells in the ovaries grow uncontrollably and form a malignant ovarian tumour. The ovaries are two small reproductive organs that produce eggs and female hormones estrogen and progesterone.

Because the ovaries sit deep inside the pelvis, tumours can grow for a significant time before causing noticeable symptoms. This is what makes ovarian cancer one of the hardest gynaecological cancers to catch early and one of the most serious when it isn’t.

Types of Ovarian Cancer

Epithelial ovarian cancer The most common type about 90% of ovarian cancers. Starts in the cells that cover the outer surface of the ovary. Includes several subtypes, the most common being high-grade serous ovarian cancer.

Germ cell ovarian tumours Develop from the egg-producing cells inside the ovary. More common in younger women and girls. Generally respond well to treatment.

Stromal cell ovarian tumours Develop in the hormone-producing tissue of the ovary. Rare. Can sometimes produce hormones, causing unusual bleeding or hormonal symptoms.

Early Signs of Ovarian Cancer

This is where ovarian cancer awareness matters most. The symptoms are real they just don’t look like cancer symptoms. They look like digestive problems, bladder issues, or general tiredness.

The key is persistence. Most of these symptoms are common and usually harmless. When they last more than a few weeks without a clear explanation, they need to be taken seriously:

• Bloating and abdominal pain — persistent bloating that doesn’t come and go but stays for weeks. Pelvic pain in women or abdominal discomfort that keeps returning without an obvious cause
• Feeling full quickly and difficulty eating — eating far less than usual before feeling uncomfortably full. Many women lose significant weight or change their eating habits over months before connecting this to something medical
• Changes in bowel habits — constipation, diarrhoea, or alternating between both without a dietary explanation
• Frequent urination and urgent urination — needing to go more often or with greater urgency than usual
• Pain during sex — persistent or worsening pain during intercourse that doesn’t have an obvious cause
• Vaginal bleeding — particularly bleeding after menopause or between periods
• Severe back pain — particularly lower back pain that doesn’t respond to usual treatments
• Unexplained weight loss — losing weight without changes to diet or activity
• Fatigue and weakness — persistent tiredness that rest doesn’t fix, particularly when combined with other symptoms

None of these symptoms alone confirms ovarian cancer. Most of the time, they won’t be cancer. But when several are present together, and when they persist for more than 2-3 weeks, a gynaecologist needs to know.

What Causes Ovarian Cancer?

The exact cause isn’t always clear. Ovarian cancer develops when something goes wrong in the DNA of ovarian cells but what triggers that isn’t fully understood. What is understood is which factors increase the risk:

BRCA1 gene mutation and BRCA2 gene mutation Inherited mutations in BRCA1 or BRCA2 significantly increase ovarian cancer risk. Women with BRCA1 mutations have a 35-70% lifetime risk of ovarian cancer. Women with BRCA2 mutations have a 10-30% lifetime risk. This is why genetic testing and counselling matters for women with a strong family history.

Family history of ovarian cancer A mother, sister, or daughter with ovarian cancer increases personal risk. Multiple relatives with ovarian or breast cancer particularly diagnosed young suggests a genetic predisposition that deserves evaluation.

Age Ovarian cancer is more common after 50, though it can occur at any age. Younger women are not immune, and germ cell tumours are actually more common in younger women.

Hormonal and reproductive factors Never having been pregnant, early first period, late menopause, and long-term hormone replacement therapy all increase the cumulative hormonal exposure that may raise risk.

Obesity Excess body fat is associated with higher estrogen levels and increased ovarian cancer risk, particularly for certain subtypes.

Endometriosis Long-standing endometriosis particularly untreated is associated with a modestly increased risk of certain ovarian cancer types.

Ovarian Cancer Screening: Who Should Get Tested and When

This is an honest and important point: there is currently no reliable standard screening test for ovarian cancer in women without symptoms. Unlike cervical cancer which has the Pap smear or breast cancer which has mammography no test has been proven to reliably reduce ovarian cancer deaths through population-wide screening.

However, for high-risk women those with BRCA mutations or strong family history of ovarian cancer monitoring is still recommended:

Transvaginal ultrasound (TVUS test) An ultrasound probe placed inside the vagina gives a close-up view of the ovaries and can detect abnormal masses or ovarian tumours. Recommended every 6-12 months for high-risk women from around age 30-35, or 5-10 years before the youngest relative’s age at diagnosis.

CA-125 blood test Measures the level of CA-125 a protein that is often elevated in ovarian cancer. Not reliable as a standalone screening tool because CA-125 can be raised by endometriosis, fibroids, pelvic infections, and other benign conditions. Used alongside transvaginal ultrasound in high-risk monitoring.

Pelvic examination A physical examination allows the doctor to feel the ovaries for abnormal size or texture. Not sensitive enough to detect most early ovarian tumours, but part of routine gynaecological care.

For women with BRCA1 or BRCA2 mutations, risk-reducing salpingo-oophorectomy surgical removal of the ovaries and fallopian tubes is often recommended after childbearing is complete. This reduces ovarian cancer risk by over 80%.

Diagnosis of Ovarian Cancer

When symptoms are present or monitoring raises a concern, diagnosis involves:

Transvaginal ultrasound First-line imaging to characterise any mass found in or around the ovary its size, whether it’s solid or fluid-filled, and features that suggest whether it’s benign or a malignant ovarian tumour.

CA-125 blood test Elevated CA-125 alongside an abnormal ultrasound significantly increases the likelihood of ovarian cancer.

CT scan for ovarian cancer Assesses the extent of disease whether cancer has spread to the abdomen, pelvis, lymph nodes, or distant organs.

MRI for ovarian cancer Provides more detailed characterisation of ovarian masses, particularly useful when ultrasound findings are unclear.

Ovarian biopsy Tissue sampling to confirm the diagnosis. In ovarian cancer, biopsy is often done as part of surgery rather than before it partly because surgery is both diagnostic and therapeutic.

Ascites fluid analysis When fluid has accumulated in the abdomen ascites a sample can be drawn and tested for cancer cells.

Stages of Ovarian Cancer

Stage 1 — cancer is confined to one or both ovaries. Excellent prognosis 5-year survival above 90% with treatment. Surgery alone may be sufficient.

Stage 2 — cancer has spread to nearby pelvic organs the uterus, fallopian tubes, or bladder. Still very treatable.

Stage 3 — cancer has spread within the abdomen or to lymph nodes. The majority of ovarian cancers are diagnosed at this stage. Treatment involves surgery and chemotherapy.

Stage 4 — cancer has spread to distant organs such as the lungs or liver. Treatable but not usually curable. Treatment focuses on controlling disease and maintaining quality of life.

Treatment of Ovarian Cancer

Ovarian cancer surgery Surgery is the cornerstone of treatment for most stages. The type of surgery depends on the stage and the patient’s age and fertility wishes:

• Tumour debulking surgery — the main surgical approach for advanced ovarian cancer. The goal is to remove as much tumour as possible the ovaries, fallopian tubes, uterus, visible tumour deposits in the abdomen, and affected lymph nodes. The amount of tumour left behind after surgery directly affects how well chemotherapy works
• Laparoscopic surgery for ovarian cancer minimally invasive keyhole surgery. Used in early-stage disease and for staging. Faster recovery, less blood loss
• Robotic surgery for ovarian cancer — robotic-assisted procedures offer greater precision in complex cases. Available in select centres
• Fertility-preserving surgery — in selected young women with early-stage disease, it may be possible to remove only the affected ovary and preserve the uterus and other ovary, retaining the possibility of future pregnancy

Chemotherapy for ovarian cancer Given after surgery or before surgery in some advanced cases to shrink the tumour first. The standard regimen combines carboplatin and paclitaxel. Most ovarian cancers respond initially, though recurrence is common in advanced disease.

Targeted therapy for ovarian cancer PARP inhibitors olaparib, niraparib, rucaparib are particularly effective in women with BRCA1 or BRCA2 mutations. They are used as maintenance therapy after chemotherapy to delay or prevent recurrence. A significant advance in ovarian cancer treatment over the last decade.

Hormone therapy for ovarian cancer Used in certain subtypes particularly stromal cell tumours and some low-grade cancers where hormones drive cancer growth. Less commonly used than in breast cancer.

Radiation therapy for ovarian cancer Not a standard first-line treatment for most ovarian cancers, but sometimes used for specific situations isolated recurrence in a particular location, or palliative treatment of painful metastases.

Immunotherapy for ovarian cancer Still largely investigational for ovarian cancer, though clinical trials are ongoing and some checkpoint inhibitors show promise in specific subtypes.

Palliative care for ovarian cancer For advanced and recurrent disease, palliative care manages symptoms abdominal pain, ascites, fatigue, nausea and focuses on maintaining the best possible quality of life. It works alongside active treatment.

Complications of Ovarian Cancer

When ovarian cancer is diagnosed at an advanced stage or continues to grow despite treatment, it can lead to several complications. Early diagnosis and timely treatment significantly reduce the risk of these problems.

Ascites (Fluid Build-up in the Abdomen)

One of the most common complications of advanced ovarian cancer is ascites, a build-up of fluid inside the abdomen. This can cause abdominal swelling, bloating, discomfort, shortness of breath, and difficulty eating. In some cases, the fluid may need to be drained to relieve symptoms.

Bowel Obstruction

As the cancer spreads within the abdomen, it may press on or block the intestines. This can lead to severe abdominal pain, persistent vomiting, constipation, inability to pass stools or gas, and abdominal swelling. Bowel obstruction is a medical emergency that often requires hospital treatment.

Pleural Effusion

Ovarian cancer can sometimes spread to the lining around the lungs, causing pleural effusion, where fluid collects around the lungs. This may lead to shortness of breath, chest discomfort, persistent cough, and difficulty breathing. The fluid may need to be drained to improve breathing.

Blood Clots (Deep Vein Thrombosis and Pulmonary Embolism)

Women with ovarian cancer have a higher risk of developing blood clots due to the cancer itself, surgery, chemotherapy, and reduced physical activity. Symptoms include pain, swelling, warmth, or redness in one leg. If a clot travels to the lungs (pulmonary embolism), it can cause sudden chest pain, severe breathlessness, or coughing up blood and requires immediate emergency care.

Malnutrition and Weight Loss

Many women experience poor appetite, early fullness, nausea, and weight loss during advanced ovarian cancer or chemotherapy. Maintaining adequate nutrition is important to support recovery, improve strength, tolerate treatment better, and enhance overall quality of life. A dietitian may be recommended as part of cancer care.

 Can Ovarian Cancer Be Prevented?

There is no guaranteed way to prevent ovarian cancer. However, certain lifestyle measures and medical strategies may help reduce the risk, especially in women with a strong family history or inherited genetic mutations.

Maintain a Healthy Weight

Being overweight or obese has been linked to a higher risk of certain types of ovarian cancer. Eating a balanced diet and maintaining a healthy body weight may help lower the risk.

Stay Physically Active

Regular exercise supports overall health, helps maintain a healthy weight, and may reduce the risk of several cancers, including ovarian cancer. Aim for at least 150 minutes of moderate physical activity each week.

BRCA Genetic Counselling

Women with a strong family history of ovarian or breast cancer should consider genetic counselling and BRCA1/BRCA2 testing. Identifying inherited mutations allows doctors to recommend appropriate screening and preventive strategies.

Oral Contraceptive Pills

Research has shown that using oral contraceptive pills for several years may reduce the risk of ovarian cancer. However, birth control pills also carry potential risks and should only be taken after discussing the benefits and risks with a doctor.

Pregnancy and Breastfeeding

Women who have had one or more full-term pregnancies and those who breastfeed may have a lower risk of developing ovarian cancer. Although these factors may offer some protection, they do not eliminate the risk completely.

Risk-Reducing Surgery for High-Risk Women

Women with BRCA1 or BRCA2 gene mutations who have completed their families may be advised to undergo risk-reducing salpingo-oophorectomy, a surgery that removes both ovaries and fallopian tubes. This procedure can reduce the risk of ovarian cancer by more than 80% and is considered the most effective preventive option for women at very high genetic risk.

Life After Ovarian Cancer Treatment

Finishing ovarian cancer treatment is a major milestone, but recovery does not end when chemotherapy or surgery is over. Your body and mind both need time to heal. Every woman’s recovery is different, and it may take several months before you start feeling like yourself again.

Energy and Fatigue

Feeling tired for weeks or even months after treatment is common. Surgery, chemotherapy, and emotional stress all contribute to fatigue. Try to balance rest with light physical activity. Gentle walking, stretching, and gradually increasing daily activities often help improve energy levels over time.

Emotional Recovery

Many women experience anxiety, fear of recurrence, sadness, or changes in confidence after treatment. These feelings are completely normal. Speaking with your doctor, joining a cancer support group, or talking to a mental health professional can make recovery easier.

Returning to Daily Life

Most women gradually return to work, household activities, and social life after treatment. Recovery depends on the type of surgery performed, chemotherapy side effects, and overall health. It is important to avoid rushing and allow your body enough time to recover.

Healthy Lifestyle After Treatment

Although no lifestyle change can completely prevent recurrence, maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, whole grains, and lean protein, avoiding smoking, limiting alcohol, and staying physically active may support overall health and recovery.

Family and Social Support

Recovery becomes easier with emotional support from family, friends, and caregivers. Open communication about physical limitations and emotional concerns can reduce stress and improve quality of life throughout recovery.

Follow-up Care After Ovarian Cancer

Regular follow-up appointments are an important part of ovarian cancer care. Even after successful treatment, your doctor will continue monitoring your health to detect recurrence early and manage any long-term side effects.

Regular CA-125 Blood Tests

If your CA-125 level was elevated before treatment, your doctor may repeat the test every 3–6 months during the first two years and less frequently thereafter to monitor for recurrence.

Imaging Tests

CT scans or MRI scans are not performed routinely for everyone but may be recommended if new symptoms develop or if blood tests suggest the cancer may have returned.

Monitoring for Recurrence

Contact your doctor if you develop persistent bloating, pelvic pain, abdominal swelling, loss of appetite, unexplained weight loss, changes in bowel habits, or increasing fatigue. These symptoms do not always mean cancer has returned, but they should be evaluated promptly.

How Long Does Follow-up Continue?

Most women are followed every 3–6 months during the first two years after treatment, every 6–12 months for the next three years, and then annually. The exact schedule depends on the stage of cancer, treatment received, and your overall health.

Managing Long-Term Health

Follow-up visits also help manage treatment-related side effects, monitor nutritional health, support emotional well-being, and encourage healthy lifestyle habits that improve overall quality of life after ovarian cancer.

Ovarian Cancer Recurrence

Ovarian cancer recurrence is unfortunately common about 70% of women with advanced ovarian cancer will experience recurrence after initial treatment. Recurrent ovarian cancer is treated with further chemotherapy, targeted therapy, or clinical trial drugs. Many women go through multiple lines of treatment over years. This is why ongoing follow-up with a gynaecologic oncologist regular CA-125 monitoring and imaging is so important after treatment.

Ovarian Cancer Myths — Busted

“Ovarian cancer only affects older women.” It is more common after 50, but germ cell ovarian tumours are particularly common in young women and girls. Women with BRCA mutations may develop it in their 30s and 40s. Age is not protection.

“Ovarian cancer is always caused by genetics.” Most ovarian cancer occurs in women without a family history or known genetic predisposition. Genetics increases risk it doesn’t determine it. The majority of cases are not inherited.

“If I don’t have symptoms, I don’t need to worry.” Early ovarian cancer often has no symptoms at all. This is exactly why women with risk factors BRCA mutations, family history, long-standing endometriosis need specialist monitoring even when they feel completely well.

When Should You See a Doctor?

Don’t dismiss symptoms that persist. See a gynaecologist or book an online ovarian cancer consultation if you have:

• Persistent bloating or abdominal pain lasting more than 2-3 weeks
• Feeling full quickly, difficulty eating, or significant appetite change
• Frequent or urgent urination without a urinary cause
• Unexplained vaginal bleeding
• Pain during sex that is new or worsening
• Persistent fatigue alongside any of the above

And if you have a family history of ovarian or breast cancer, or know you carry a BRCA1 or BRCA2 mutation speak to a gynaecologic oncologist about your monitoring plan. Book an online gynaecologic oncologist consultation through HealthPil for specialist guidance from home.

How HealthPil Can Help

HealthPil connects you with experienced gynaecologists and gynaecologic oncologists for ovarian cancer screening guidance, CA-125 test interpretation, second opinions on diagnosis, treatment planning, and follow-up care. Whether you have symptoms, a family history, or a recent diagnosis and want a second opinion, expert help is available through an online consultation without a long wait.

Summary

Ovarian cancer often causes vague symptoms such as persistent bloating, pelvic pain, early fullness, frequent urination, and unexplained fatigue. Women with BRCA mutations or a family history are at higher risk. Although there is no routine screening test for everyone, high-risk women may benefit from regular CA-125 testing and transvaginal ultrasound. Treatment includes surgery, chemotherapy, targeted therapy, and supportive care depending on the stage. Early diagnosis greatly improves treatment outcomes. If symptoms persist for more than 2–3 weeks, consult a gynaecologist or book an online consultation through HealthPil.