Why Are Ovarian Cancer Signs and Symptoms Hard to Identify?

Vague symptoms can delay early diagnosis

Woman holding ovarian cancer awareness symbol.

Vague symptoms can delay early diagnosis

It makes sense that the earlier cancer is diagnosed, the easier it is to treat successfully. Many types of cancer have screening tests or early warning signs that help with early detection. But ovarian cancer is an exception due largely to its vague symptoms.

“In the early stages of ovarian cancer, women may have few or no symptoms,” says Teresa Longoria, MD, a gynecologic oncologist at Scripps Clinic Anderson Medical Pavilion in La Jolla and Prebys Cancer Center in San Diego. “If there are symptoms, they are usually mild and can be mistaken for other common conditions.”

Only about 20% of ovarian cancers are found at an early stage, according to the American Cancer Society. Most cases are diagnosed when the cancer is at an advanced stage, which is why it’s important to know the risk factors and early signs.

When ovarian cancer is found early, about 94% of patients live longer than five years after diagnosis, according to cancer statistics.

What is ovarian cancer?

The ovaries are walnut-sized reproductive organs on either side of the uterus that produce eggs and the hormones estrogen and progesterone.

Ninety percent of ovarian cancer starts in the lining of the ovaries, but it can begin in other parts of the ovary like the egg-producing cells and connective tissue.

Ovarian tumors may be benign (non-cancerous), but those that are cancerous or have the potential to become cancerous (known as borderline) can spread to the pelvis and other parts of the body.


There are three main types of ovarian cancer:


  • Epithelial tumors form in the tissue that covers the ovaries and account for about 90 percent of ovarian cancers.
  • Stromal tumors begin in the ovarian cells that produce hormones and are usually diagnosed earlier than other tumors.
  • Germ cell tumors begin in the cells that produce eggs; they are rare and tend to affect younger women.

The American Cancer Society estimates nearly 20,000 women will be diagnosed with ovarian cancer in 2023. About 13,000 women will die from the disease.

What are the symptoms of ovarian cancer?

The most common ovarian cancer symptoms include:

  • Bloating
  • Pelvic or abdominal discomfort
  • Unexplained weight loss or weight gain
  • Nausea, diarrhea, constipation, frequent urination
  • Loss of appetite
  • Abnormal vaginal bleeding
  • Menstrual changes
  • Fatigue
  • Pain during sex
  • Back pain

Having any of these symptoms does not necessarily mean you have ovarian cancer. However, if you experience them persistently, or they become stronger or more frequent, it’s a good idea to see your primary care doctor or gynecologist to determine the cause.

“It is always better to err on the side of caution,” says Dr. Longoria. “We want to find out what is causing your symptoms. If you do have ovarian cancer, we can start treatment right away.”

Ovarian cancer risk factors

Ovarian cancer affects about 1 in 78 women. It can develop at any age, but these risk factors may increase the chances of developing the disease.

Increasing age

Ovarian cancer is most common in women ages 50 to 60 after menopause. About half of the women diagnosed with ovarian cancer are 63 or older.

Inherited gene mutations

A significant percentage of ovarian cancers are caused by inherited gene mutations. Women with a mutation in breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2) not only have an increased risk of breast cancer but also an increased risk of ovarian cancer. Women with Lynch syndrome are at increased risk of developing several types of cancer, including ovarian cancer.

Family history

Women who have close relatives with ovarian cancer have an increased risk.

Menstruation and menopause age

Women who started their periods at an early age, or began menopause a later age, may have a greater risk.

Not having children

Women who have never given birth or have had trouble getting pregnant have a higher risk of ovarian cancer.

Personal history of endometriosis

This condition occurs when tissue from the lining of the uterus grows elsewhere in the body and can be associated with less common types of ovarian cancer.

Reducing your risk

Anything that stops ovulation for a time reduces your risk for ovarian cancer, for example: birth control pills, pregnancy or breastfeeding.

Diagnosis and treatment

There are no standard screening exams for ovarian cancer. Doctors use several tests, including a physical exam, lab tests, imaging exams and a biopsy to diagnose ovarian cancer. Ovarian cancer stages range from stage 1 (cancer is only in the ovary) to stage 4 (cancer has spread to distant organs).

“We develop personalized treatment plans depending on the stage of the cancer, the patient’s overall health and other factors,” says Dr. Longoria. “Treatment usually involves a combination of surgery to remove the tumor and chemotherapy.”

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