Ovarian cancer has long been dubbed a ‘silent killer’ because its symptoms are all too easy to overlook.
It’s one of the eleven cancers on the rise, driven exclusively by increasing numbers of young women developing the disease.
Studies are yet to pinpoint a precise reason for the surge, but experts from Imperial College London believe rising obesity rates and smoking are likely to play a role.
Ovarian cancer is one of the most common cancers in the UK, with a staggering 7,7000 new cases every year.
It is also one of the deadliest forms of the disease, with just 40 per cent of women surviving for ten or more years after diagnosis.
There are roughly 4,000 deaths from ovarian cancer in the UK every year, mostly because the disease is typically diagnosed at a late stage, when treatment is more difficult.
The earliest symptoms of ovarian cancer are often vague and easily dismissed by GPs as signs of other – less severe – gynaecological conditions.
With this in mind, these are the classic warning signs that every woman needs to be aware of and should never be ignored.
It’s estimated that there are more than 7,700 new cases of ovarian cancer in the UK each year
What is ovarian cancer?
Ovarian cancer occurs when abnormal cells in the ovaries or fallopian tubes grow and divide, until a tumour forms.
If it’s not caught early, cancer cells can grow into the surrounding tissues and spread to other areas of the body – where the disease is a lot harder to treat.
The ovaries are the two glands buried deep within the pelvis, involved in a woman’s menstrual cycle and fertility. This is also where the hormones oestrogen and progesterone are made.
As a result of their positioning, symptoms can be vague or mistaken for gastrointestinal issues like irritable bowel syndrome, bloating or even urinary tract infections (UTIs).
What are the types of ovarian cancer?
There are several types of ovarian cancer, which depend on where exactly in the female reproductive system the disease begins.
Epithelial ovarian cancer is the most common, accounting for around 90 per cent of cases, and occurs when the cancer develops on the surface of the ovary.
This type of cancer also includes cancer of the fallopian tube, which connects to ovary to the uterus.
Germ cell cancers are much rarer and tend to affect younger women in their twenties and thirties, starting in the cells that develop into eggs.
Sex cord stromal tumours account for just five per cent of cases, and begin in the tissue that supports the ovaries and produce hormones.
Persistent bloating
Research shows that ovarian cancer symptoms develop a lot earlier than previously thought.
Experts at Imperial College London found that women diagnosed with the disease bought painkillers and over-the-counter indigestion treatments up to eight months before their diagnosis to help alleviate painful bloating.
‘Many women experience bloating at some point, but with ovarian cancer it tends to be persistent and not linked to specific foods,’ Dr Asiya Maula, an NHS GP, explains.
‘If it’s happening most days or doesn’t improve, it’s important to take note.’
In advanced stages, bloating can become so severe that the abdomen becomes visibly swollen, and can even be mistaken for pregnancy.
This swelling is caused by a build-up of excess fluid – called ascites – in the tissue that lines the abdominal wall, as cancer cells irritate the lining.
Irregular bleeding
The key with ovarian cancer is knowing what’s normal for you.
‘It’s not about occasional symptoms, but those that are new, persistent and happening more frequently,’ Dr Maula says.
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Should women be routinely screened for ovarian cancer?
‘Understanding what is normal for your body and noticing when something changes can make a significant difference.’
Spotting or bleeding in between periods is one of the most overlooked early warning signs of ovarian cancer, as women just assume there cycle is early.
But if spotting occurs with other symptoms such as persistent bloating – especially if bleeding between periods is unusual for you – it should be discussed with your GP.
Needing to pee more frequently
Needing to use the toilet more often than usual isn’t always a cause for concern and can be caused by less serious issues such as UTIs, diabetes, pregnancy or even just lifestyle factors – like drinking a lot of caffeine.
But it can also be a sign of ovarian cancer as tumours grow and press against the bladder, reducing its capacity and causing a more frequent urge to urinate.
A build-up fluid in the abdomen can also put pressure on the bladder.
This seemingly innocent symptom, particularly when experienced with unexplained weight changes and abdominal pain, can be a warning sign of ovarian cancer.
‘If something feels differing or ongoing, it’s always work speaking to a GP,’ Dr Maula advises.
Feeling full more quickly
Ovarian cancer often presents with subtle, nondescript symptoms, making it challenging to diagnose early.
One such symptom is feeling full after eating only a small amount of food.
This can happen when ovarian tumours press against the stomach and other digestive organs, reducing their capacity and making you feel full quicker.
However, the sensation can also be triggered by gastrointestinal issues, infections, certain medications like pain killers, stress and anxiety and is not always a sign of ovarian cancer.
Dr Maula added: ‘If someone finds they are getting full much more quickly than usual, or struggling to finish meals, that can be a sign something isn’t quite right.
‘It’s a change that people often don’t connect to anything serious but early changes are when we have the best chance of identifying problems.’
Persistent abdominal pain
Ongoing discomfort or pain in the lower abdomen or pelvic area is another common symptom that can be mistaken for something less serious, like period pain.
But persistent abdominal pain can also result from ovarian cancer – as tumours grow, excess fluid builds up or the cancer spread to other parts of the abdomen causing widespread pain.
Although it is much more likely to be caused by something much less serious like constipation or menstrual cramping, Dr Maula says it shouldn’t be overlooked.
‘Any persistent discomfort in this areas that doesn’t have an obvious cause should be checked.
‘Even if the pain is mild, it’s the consistency and persistence that matters.’
When to see a doctor
Whilst all these symptoms don’t necessarily mean cancer, experts stress that patterns are important and that symptoms that are new, frequent or worsening should always be assessed.
Dr Maula added that too often women often endure health issues silently and only seek help when their symptoms become unbearable.
‘People often wait until symptoms become severe, but early changer are when we have the best chance of identifying problems.
‘If any of these symptoms are unusual for you, occur together or are ongoing, it’s always worth speaking to a GP.’
How to minimise your risk
Most cancers become more common with age, but ovarian cancer particularly so.
The risk increases sharply at around 45 years old as women approach the menopause.
Those who start their period early and go through the menopause late – over the age of 55 – or who have not had a baby are at an increased risk as these factors may mean they’ve released more eggs.
There is some research to suggest that women on Hormone Replacement Therapy (HRT), used to treat symptoms of the menopause, may be at a very slight increased risk of the cancer, but the risk is still very small and decreases when HRT is stopped.
Anything that reduces the overall risk of cancer will also minimise the risk of ovarian cancer.
Whilst it isn’t typically preventable, with just 10 per cent of cases thought to be linked to lifestyle factors, maintaining a healthy weight, not smoking, and staying away from asbestos can all help minimise the risk.
Taking the combined contraceptive pill is also thought to reduce the risk, with its protective effect lasting at least 30 years after you stop taking it.
Having children also seems to reduce the risk, with the more children a woman has, the lower her risk.
The need to screen
Currently there is no national screening programme for ovarian cancer.
It is typically diagnosed using a mix of scans and biopsies to remove tissue or possibly the ovaries.
But UK and US researchers are now developing a blood test to look to detect what ovarian cancer sheds into the bloodstream, at its earliest stages.
They hope their findings will help improve the early diagnosis of ovarian cancer resulting in better patient outcomes and lower costs to the healthcare system.
