Ovarian cancer symptoms are remarkably absent in the early stages of the disease. This is explained by the fact that the ovaries are so deeply buried that is not surprising that ovarian cancer in stage I and II does not produce any pain symptoms.
As pointed out above, symptoms occur only in the late stages (stage III or IV). In stage III when there is local invasion, there may be some pelvic discomfort or some bladder irritation with frequent urination. Many women at this stage are still symptom free. For this reason I cannot overemphasize the importance of a preventative yearly bimanual pelvic examination until the age of 70 years, as the incidence of ovarian cancer starts declining only then.
As explained above, when the cancer cysts rupture there is usually lower abdominal pain. In the weeks following this event there is new abdominal discomfort from the multiple new metastases.
Other metastases produce symptoms in the liver(pain right upper abdomen), lungs( shortness of breath) and elsewhere in the body. When cells are shed into the abdomen and they multiply, it leads to a cancerous peritonitis with fluid accumulations(ascites), which can lead to bloating and a massive abdominal protrusion. This is a very poor prognostic sign. Also, loss of appetite and weight loss are poor prognostic indicators.
1. V.T. DeVita et al. : Cancer- Principles & Practice of Oncology, Vol.1, 4th edition. J.B. Lippincott Co., Philadelphia, USA, 1993. Ovarian cancer chapter.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Ovarian cancer chapter.
3. S Ginath et al. Int J Oncol 2001 Jun;18(6):1133-1144.
4. Y.-L. Hu et al. J Natl Cancer Inst 2001 May 16;93(10):762-767.
5. MKTuxen et al. Br J Cancer 2001 May;84(10):1301-1307.
6. U Wagner et al. Clin Cancer Res 2001 May;7(5):1154-1162.
7. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc