Why Ovarian Cancer Is Often Diagnosed Late
Ovarian cancer accounts for the highest mortality rate among gynaecological cancers — not because it is untreatable, but because most cases are detected at an advanced stage. The ovaries are deep within the pelvis, and early tumours rarely cause pain. Women and their doctors often attribute the first symptoms to digestive issues, stress, or the normal changes of ageing.
As a gynaecological oncologist, I see patients every week who were told for months — sometimes years — that their bloating or pelvic discomfort was irritable bowel syndrome. By the time the correct diagnosis was reached, the disease had already spread. This does not have to be the story.
The Four Early Warning Signs
Ovarian cancer does produce symptoms. They are subtle and non-specific, which is why they are missed — but if four or more of the following occur more than 12 times a month, a specialist review is warranted:
- Bloating — persistent, not related to eating
- Pelvic or abdominal pain — a dull ache, pressure, or cramping that does not resolve
- Feeling full quickly — even after small meals
- Urinary urgency — needing to urinate more often or more urgently than usual
Secondary symptoms that should also prompt investigation include unexplained weight loss, fatigue, changes in bowel habits, and lower back pain.
Who Is at Higher Risk?
- Family history — a first-degree relative with ovarian or breast cancer raises lifetime risk substantially
- BRCA1 or BRCA2 gene mutations — carriers have a 15–40% lifetime risk compared to 1.3% in the general population
- Personal history of breast, uterine, or colorectal cancer
- Endometriosis — associated with clear-cell and endometrioid ovarian cancers
- Nulliparity — never having been pregnant
- Age — over 50, especially post-menopause
If you carry two or more of these risk factors and are experiencing any of the symptoms above, please do not wait. An early-stage ovarian cancer has a five-year survival rate above 90%. Late-stage disease reduces that to below 30%.
What a Diagnostic Work-up Looks Like
If ovarian cancer is suspected, investigation typically involves a pelvic ultrasound, a CA-125 blood test, and — if findings are suspicious — a CT scan of the abdomen and pelvis. It is important to know that CA-125 is not a reliable standalone screening test: it is elevated in many benign conditions and can be normal in early-stage disease.
A specialist’s clinical judgement — examining the morphology of an ovarian mass, its vascularity, bilaterality, and the clinical picture together — is what drives appropriate management. If your gynaecologist expresses concern, ask for a referral to a gynaecological oncologist before any surgery is planned.
When to Seek a Second Opinion
If you have been told that an ovarian cyst “doesn’t look concerning” but your symptoms persist, seek a second opinion from a gynaecological oncologist. Surgery for ovarian cancer should ideally be performed by a trained oncosurgeon, as incomplete cytoreduction significantly worsens prognosis.
Dr. Nishtha Tripathi Patel is an ESGO-certified gynaecological oncologist practising at Sterling Hospitals, KD Hospital, and Welcare Speciality Hospital in Ahmedabad. For consultations, call +91 76988 00333.