For too long, ovarian cancer has been branded as a “silent killer” — a disease that sneaks up undetected, only revealing itself when it’s too late to do much about it. But this label isn’t just outdated — it’s dangerously misleading.
Ovarian cancer is indeed the most lethal gynecologic malignancy, with fewer than 40% of those diagnosed surviving long-term. In the U.S. alone, approximately 12,810 lives are lost each year to this disease. However, mounting research over the past two decades challenges the idea that ovarian cancer is symptomless. In fact, subtle but consistent signs often surface months before a diagnosis — if we learn how to recognize them.
Why Screening Hasn’t Been the Answer
Over the last 25 years, countless researchers have searched for a reliable screening method to catch ovarian cancer early. Unfortunately, even large-scale clinical trials involving hundreds of thousands of participants have yielded no definitive test. In 2018, the U.S. Preventive Services Task Force gave ovarian cancer screening a “D” grade — recommending against it for the general population due to a lack of survival benefit and the potential for harm.
This absence of a trusted screening tool means that about 70% of ovarian cancer cases are diagnosed at stages III or IV, when the cancer has already spread beyond the pelvis. At these later stages, the five-year survival rate drops sharply to between 10% and 40%. By contrast, when caught early — confined to the ovaries or pelvic area — survival jumps to between 60% and 90%.
Even in advanced cases, the outlook improves if surgery can fully remove the cancer. That’s why early diagnosis is not just helpful — it’s vital.
Listening to the Body’s Early Signals
Despite the perception that ovarian cancer arrives quietly, studies — including one conducted by my own research team — have shown otherwise. In our 2000 study of 1,700 women with ovarian cancer, a striking 95% reported experiencing symptoms three to twelve months before their diagnosis.
The most common early signs included:
- Pelvic or abdominal pain
- Bloating or increased abdominal size
- Frequent or urgent urination
- Feeling full quickly or having difficulty eating
Notably, these symptoms were reported by women with both early and advanced disease. This means they’re not limited to later stages and can serve as a critical tool for early detection — if they’re recognized and acted upon.
The Problem of Misdiagnosis
One of the greatest barriers to early diagnosis is that these symptoms are often mistaken for less serious conditions. Our research revealed that many women were misdiagnosed before receiving an accurate assessment. Here’s what patients were initially told:
- 15% were told it was irritable bowel syndrome (IBS)
- 12% were told stress was to blame
- 9% received a diagnosis of gastritis
- 6% were told it was constipation
- 6% were diagnosed with depression
- 4% were told nothing was wrong
In total, nearly one-third were treated for unrelated conditions, delaying the correct diagnosis and treatment.
Distinguishing ovarian cancer from more common gastrointestinal or urinary issues can be tricky, but one key lies in symptom frequency and duration. Unlike occasional bloating or stomach discomfort, ovarian cancer symptoms are persistent. If symptoms occur more than 12 times per month and have lasted for less than a year, they warrant a closer look.
The Six Symptoms That Matter Most
To better support early detection, our team developed a symptom index — a simple tool that identifies six important signs associated with ovarian cancer:
- Bloating
- Increased abdominal size
- Feeling full quickly
- Difficulty eating
- Pelvic pain
- Abdominal pain
When these symptoms appear frequently — more than a dozen times per month — and are new (within the past year), they may point to ovarian cancer. Our index was able to identify the disease in 60% to 85% of cases — a detection rate similar to that of some blood-based diagnostic tools.
Prevention Is Still Powerful
While early diagnosis is crucial, prevention also plays a major role in reducing risk. Several factors and lifestyle choices have been linked to a lower incidence of ovarian cancer, including:
- Use of oral contraceptives
- Tubal ligation (closing the fallopian tubes)
- Pregnancy and breastfeeding
If you have a family history of ovarian or breast cancer, it’s especially important to talk with your doctor. Genetic testing may be recommended to assess your risk. In some cases, prophylactic surgery (removal of ovaries or fallopian tubes) may be advised — particularly for those with BRCA gene mutations.
Emerging research shows that up to 70% of ovarian cancers may actually originate in the fallopian tubes. As a result, some gynecologists are now offering opportunistic salpingectomy — removal of the fallopian tubes during other surgeries (like a hysterectomy) — as a preventive measure for women who are finished having children.
A Call to Awareness
It’s time to rewrite the narrative: ovarian cancer is not a silent killer. It speaks — sometimes softly, sometimes persistently — through our bodies. We just need to be better listeners.
If you’re experiencing unusual or persistent bloating, abdominal pressure, changes in appetite, or pelvic discomfort, don’t brush it off. Pay attention. Track your symptoms. And if something doesn’t feel right, advocate for yourself.
Doctors, too, must stay vigilant. Dismissing symptoms as stress, indigestion or aging can delay crucial treatment. It’s time for both patients and providers to take these signals seriously — and act on them early.
With awareness, education and proactive care, we can shift the tide and improve survival for women facing this disease. Ovarian cancer isn’t silent. It’s just waiting for us to start listening.
Barbara Goff, M.D., is a board-certified gynecologic oncologist specializing in the surgical and medical treatment of ovarian and other gynecologic cancers. This article is adapted from The Conversation, an independent nonprofit news organization dedicated to sharing the knowledge of academic experts.
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