Ovarian cancer can be deadly because it’s so stealthy.
The warning signs are vague. There’s no screening test for women without symptoms, like a mammogram for breast cancer. And it has room to grow in the pliable abdomen before it pushes on anything that would cause problems.
So ovarian cancer tends to be diagnosed at a later stage because it can be explained away by the patient — or even their primary care physician — as something else that's benign, says Dr. Jamie Bakkum-Gamez, a gynecologic oncologist at the Mayo Clinic in Rochester, Minnesota.
It can also grow from microscopic to widespread in a matter of months, she notes. All these factors make her vigilant for any warning signs in her own body.
“Every single day, I care for people with ovarian cancer,” Bakkum-Gamez tells TODAY.com.
“This is clearly something that hits home to me. … It's definitely something that's always on my mind personally.”
She has one of the risk factors — never being pregnant — and at 49, she’s aware the risk of any type of cancer increases with age.
September is National Ovarian Cancer Awareness Month. Given what Bakkum-Gamez knows, how does the doctor monitor herself for ovarian cancer?
She’s mindful of her family history because about 20% of women who develop the disease have a gene they inherited from one of their parents that puts them at risk, like BRCA mutations, Bakkum-Gamez says. No one in her family has ovarian or breast cancer, but if they did, she would have gotten genetic testing.
She eats a healthy diet, exercises, gets a pelvic exam every year and stays on top of all her other cancer screenings.
Here are ovarian cancer symptoms the doctor pays attention to in her own body:
Bloating
The sense of bloating — feeling like your pants or belts are too tight — and noticing the abdomen getting larger is the most common symptom Bakkum-Gamez sees in patients diagnosed with ovarian cancer. It’s one of the main symptoms she monitors herself for.
“People that come in with a new diagnosis say, ‘I thought I was just gaining weight because I was eating more,’ or ‘It didn't make sense as far as why I was gaining this weight,’” she says.
“Usually, their abdomen is looking more along the lines of what you would look like if you were pregnant.”
It happens because ovarian cancer tumors cause fluid, called ascites, to build up inside the abdomen, causing the belly to become hard and swollen, the American Cancer Society notes.
When Bakkum-Gamez feels bloated, she checks whether it’s because she has extra fat she can grip with her hands outside of the tough part of the abdominal wall.
“I want to reassure myself that it's extra fat” caused by eating more or exercising less, she says, or that the bloating goes away with a bowel movement.
If not, the concern is there might be excess fluid pushing outward from the inside of the abdomen.
But many women gain abdominal fat during menopause, which adds to the ambiguity and difficulty of telling body changes and symptoms apart. “It's very frustrating,” Bakkum-Gamez says.
Feeling Full Quickly
This may happen because a tumor or fluid buildup in the abdomen can limit how much food the stomach can hold.
Bakkum-Gamez checks herself for this symptom, which is known as early satiety.
“If you're hungry and you eat a small amount of food, and you feel full pretty fast … that should prompt someone to be evaluated,” she says.
Frequent Urination
Similar to what happens with the stomach, if there's a large mass taking up space in the pelvis, the bladder can't fill up all the way and hold as much urine as it normally would, Bakkum-Gamez notes.
She often asks patients: How many times do you get up to go to the bathroom at night?
“It's not uncommon that those individuals have to get up to go once, twice, sometimes three or four times at night to go urinate,” the doctor says.
Bowel Habit Changes
This could mean constipation or diarrhea.
It happens because ovarian cancer travels on the surface of the lining of the abdomen and pelvis, and that lining covers the intestines as well, Bakkum-Gamez explains.
Small tumors on the surface of the bowel could lead to functional changes. It's also possible a large mass could press on the rectum or the sigmoid colon — the last portion of the large intestine — and cause constipation, she adds.
What Are the Risk Factors for Ovarian Cancer?
The American Cancer Society says the risk factors include:
- Being older — Bakkum-Gamez’s patients are typically in their early to mid-60s.
- Inherited gene mutations such as BRCA1, BRCA2 or Lynch syndrome. Women who have one of them may benefit from risk-reducing surgery that removes the ovaries and fallopian tubes. It’s now recommended that women going in to have their tubes tied undergo opportunistic salpingectomy, or the removal of fallopian tubes, to eliminate that as a potential source for ovarian cancer to start, Bakkum-Gamez says.
- Starting your period at a younger age — before 12 years old.
- Going through menopause later — after the age of 52.
- Never being pregnant.
Diagnosing Ovarian Cancer
Other ovarian cancer symptoms include vaginal bleeding, particularly after menopause, pelvic pain, and abdominal or back pain, according to the Centers for Disease Control and Prevention.
If any symptoms persist, meaning they last a week or two and don’t go away, it’s important to get evaluated, Bakkum-Gamez says. A doctor may feel ovarian masses during a pelvic exam and sometimes during an abdominal exam.
A pelvic ultrasound is the most sensitive imaging for the ovaries and fallopian tubes, she notes.
“(But) imaging has not been a successful way to pick up early cancers because they're so small that imaging won't capture them,” Bakkum-Gamez adds.
A blood test known as CA-125 can measure tumor markers in the context of ovarian cancer, but it can be elevated for other reasons so it’s not a reliable screening test, the American Cancer Society notes.
"We don't have a screening test for (ovarian cancer), that's really the big thing ," Bakkum-Gamez says.
"It's not because people around the country and the world haven't been trying to develop an effective screening test for this cancer. It’s simply that it has not yet happened."
TODAY’s Symptom Check series features doctors, specialists and health experts who reveal the warning signs they’d look for in their own body when it comes to cancer and other diseases.
