Early symptoms of ovarian cancer are difficult to spot as they're often mistaken for other conditions such as sciatica, irritable bowel syndrome, and constipation. It's one of the reasons why ovarian cancer is the fifth most common cause of death from cancer in women around the world.
Why is this happening? Well, lack of awareness is playing a worrying role. When it comes to cancer, we all try to keep on top of checks and available tests. Whether that's looking for lumps when it comes to knowing how to check for breast cancer, tracking cancerous moles, or attending our cervical screening. But ovarian cancer is still flying under the radar.
Here, one woman speaks to woman&home about her experience of diagnosis, and we speak to experts including an NHS GP about the reasons behind these concerning statistics and find out how to check for early signs of ovarian cancer.
Early symptoms of ovarian cancer: "It was clear something was very wrong"
At first, former project manager Adele, 53, was relieved when her medical provider suggested her problems were due to an ovarian cyst. But it turned out to be much more serious.
My symptoms started when, aged 42, I noticed a shooting pain down my buttock and left leg. Six years earlier I'd had breast cancer and was terrified it had returned. But, after a clear bone scan, the doctor reassured me it was sciatica.
Over the next year or so more symptoms appeared. I began needing to pee every hour but although I was tested for urine infections nothing was found. I was also constipated.
I believed wrongly—like many other women— that a cervical smear would pick up any gynecological cancer, so I requested one. After a while, it was clear something was very wrong. My belly was so swollen. My belly button was tender and when a nurse friend pressed my stomach I felt a sharp left-sided pain. I also had persistent abdominal pain—all signs I now know of ovarian cancer but at the time I was unaware.
When the doctor thought I had an ovarian cyst I was relieved. But after the CA125 blood test, an ovarian ultrasound scan, and having five liters drained from my abdomen as I was so uncomfortable, I was referred to a specialist. My husband Tony, now 57, came with me and as the consultant delivered the verdict—stage 3C (of 4) ovarian cancer—my heart fell. Even so, having survived breast cancer, I wasn't as scared as I might have been. That was before he delivered the news that my life expectancy could be as little as five years. All I could think of was my daughter, Zindzi, 12. I was worried about what would happen to her without a mum.
Fortunately, treatment was successful, but my history of breast and ovarian cancer at a young age strongly suggested a genetic link. I was found to have a BRCA2 gene mutation, which increases the risk of breast, ovarian, and some cases of prostate cancer. I later discovered numerous relatives on my Dad's side of the family have had these cancers.
Thankfully, nine-and-a-half years after my initial diagnosis, despite a recurrence, I'm cancer-free and an active fundraiser for Ovacome (opens in new tab), organizing an annual Champagne tea party and fashion show. I've lived to see my daughter through university and into her first job. And the best news of all—Zindzi, now 22, has had a BRCA gene test and it's clear.
7 symptoms of ovarian cancer
All the early symptoms of ovarian cancer may be seen as innocuous, and ones you'd associate more with an erratic digestive system, rather than with cancer. But recognizing what’s abnormal for you could be a lifesaver, explains Dr Sharon Tate, head of primary care development at Target Ovarian Cancer (opens in new tab).
"You don’t need to have all these symptoms before you see your doctor—having just one that’s new and persistent needs your attention," she says.
The four main symptoms are:
- Bloating or swelling in the abdominal area (more than 12 times a month)
- Feeling full quicker than normal when eating
- Abdominal or pelvic pain
- Needing to pee more often
Other symptoms include:
- Weight loss
- Back pain
- Changes in bowel habits (going more or less often)
- Extreme tiredness
Worryingly, according to a poll of 1,000 women by Target Ovarian Cancer, 90% of women still don't know the four main symptoms of ovarian cancer. So what should we be on the lookout for and when is it time to visit the doctor?
The Robin Cancer Trust (opens in new tab) recommends asking these questions about your symptoms:
- Are these symptoms persistent (won't go away)?
- Are they frequent (occur most days)?
- Are they new (started in the last 12 months)?
- Are they unusual for you?
What's the link between ovarian cancer and sciatica?
In the process of being diagnosed with ovarian cancer, many women report sciatic pain or being diagnosed with sciatica by a medical professional. This is lower back pain that radiates along the sciatic nerve, which branches from the bottom of the back through the hips, buttocks, and down each leg. It typically affects one side of the body at a time.
Ovarian cancer can be confused with sciatica, says NHS GP Dr Sonal Shah (opens in new tab), because symptoms of cancer can be quite non-specific, variable, and very similar to the symptoms of sciatica, which tend to include:
- Sharp, shooting pain in your leg, buttock or lower back
- Pain that gets worse in this area when you sit or stand still for long periods of time
- Pain that becomes worse with sudden movement, like sneezing or coughing
- A feeling of numbness in your leg, buttock or lower back
- Loss of bowel and/or bladder control
"Those with ovarian cancer may notice that their tummy has changed in size, or they feel bloated or full even if they have eaten little," Dr Shah says.
"They might notice a pain and or discomfort in the back, hips or pelvis and sometimes these symptoms might be confused with sciatica, period pain, irritable bowel syndrome or constipation." In this case, it's also important to know the symptoms of bowel cancer as early signs of the two can overlap.
She adds, "The ovaries are located deep in the pelvis and come into contact with lots of other organs and structures such as the bowel or the bladder. This is why the symptoms can be quite non-specific and there is a large overlap with other benign, non-cancerous, conditions."
How to speak to your doctor about ovarian cancer
It can be scary to bring up the idea of cancer with your doctor, with research from the Fred Hutch Cancer Research Center (opens in new tab) suggesting that many put off the conversation due to confusing medical jargon, fear of not being believed, and feeling like they're wasting their doctors time.
As symptoms of ovarian cancer are non-specific much of the time, people tend to present to their doctor later than they otherwise would. "They often try different things at home, or over the counter, first," warns Dr Verity Biggs, women’s health lead and menopause GP at H3Health.co.uk (opens in new tab). But as early diagnosis is key to reducing cancer's impact on the body, and in turn saving lives, it's vital to make an appointment.
"If you’re worried, talk to your doctor," says Dr Tate. Be prepared—make notes and track symptoms and their frequency in a diary. It can help your doctor make a speedier diagnosis. "Be honest and open about your concerns and don’t be worried about saying the C-word," adds Dr Biggs.
Symptoms can be confusing for doctors, too. If you’re over 50 and your doctor's visit results in an IBS diagnosis, Dr Tate recommends questioning this and asking for a second opinion. "A new IBS diagnosis is extremely uncommon in women over 50," she says. "If they suspect symptoms of IBS, they should also request ovarian cancer tests, too." These include a CA125 blood test and an ultrasound scan. "If both these tests indicate ovarian cancer, you’ll be referred to a specialist."
It's worth noting that other less serious problems (fibroids, non-ovarian cancers) can also raise CA125 levels, and not all women with ovarian cancer have high CA125 levels.
Know your ovarian cancer risk
It's possible to be diagnosed with ovarian cancer at any age, and with no family history of the disease. However, certain things can increase your risk.
- Several family members have had breast and/or ovarian cancers
- You had breast cancer below age 50
- You had cancer in both breasts
- Male relatives have had breast cancer
- You're over 50
- You smoke
- You're overweight
- You have a history of ovarian and/or breast cancer in your family (on either side). This could be an indication of a gene, including a BRCA gene mutation, which increases your risk
- You're of Ashkenazi Jewish origin—one in 40 Ashkenazi women has a BRCA mutation, according to the CDC (opens in new tab), compared to the 1 in 500 occurrence in other women.
Ovarian cancer screening—what is available if you are worried?
"As yet there are no effective tests available to screen at population level," explains Dr Tate, although ovarian cancer charities are funding research into this.
Until then, Dr Biggs believes we need more targeted campaigns nationally, including posters and information leaflets in surgeries and even on the back of toilet cubicles to alert us to the early symptoms of ovarian cancer. And what can you do? Be aware, know the symptoms, and seek help and a referral from your doctor if you're worried.
Ovarian cancer treatments
The other advancement is the advent of new drugs and treatment regimes, which are leading to a more personalized approach tailored to individuals. Using artificial intelligence in healthcare may even be the next step to solving the problems with ovarian cancer screening.
"Each is a baby step but, together, they mark a major stride in tackling this notoriously hard-to-treat cancer," says Dr Biggs. Some of the most exciting developments include:
- "Targeted" therapies, such as the drug Avastin, that home in on tumors and cut off their blood supply while sparing normal cells.
- "Sandwich" (neoadjuvant) therapy, in which half the chemotherapy course is given before surgery and half after surgery.
- Drugs that attack faulty genes by reactivating the repair mechanisms that normally help keep us cancer-free.
Natalia Lubomirski is a health journalist with 14 years experience in the publishing industry. She has worked for a number of well-known magazines and websites including Marie Claire, marieclaire.co.uk, woman&home, Top Sante, Boots and The Telegraph.
She likes to think she practices what she preaches when it comes to health and fitness. She loves the great outdoors and you’ll often find her up a mountain somewhere. She’s climbed eight major mountain ranges across four continents and hit the summit of Half Dome (in Yosemite) during her honeymoon.
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