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Early detection of epithelial ovarian cancer: Role of symptom recognition

Barbara Goff, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Ovarian cancer is the second most common gynecologic malignancy and the most common cause of death among women with gynecologic cancer [1]. This poor prognosis is due, in large part, to the fact that most women are diagnosed at an advanced stage, while early stages of the disease are potentially curable. Unfortunately, attempts to develop screening programs for epithelial ovarian cancer using pelvic imaging or tumor markers have not yet been successful. The identification of epithelial ovarian cancer symptoms to aid early detection has become a focus of clinical research.

Epithelial carcinoma of the ovaries, fallopian tubes, and peritoneum are clinically similar. Evidence suggests that these diseases have a common pathogenesis, and may be initiated in the fallopian tubes. The term ovarian cancer will be used in this topic to refer to disease of any of these three sites.

Early detection of epithelial ovarian cancer through symptoms recognition is reviewed here. Screening and diagnosis of epithelial ovarian cancer are discussed separately. (See "Screening for ovarian cancer" and "Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: Clinical features and diagnosis".)


Presence of early symptoms — Historically, epithelial ovarian cancer was called the "silent killer" because symptoms were not thought to occur until very late in the course of the disease [2]. Advanced epithelial ovarian cancer typically presents with abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases; dyspnea is occasionally present due to a pleural effusion. However, studies have found that symptoms occur in many women even at early stages of the disease [3-8].

Most women with epithelial ovarian cancer have pelvic or abdominal symptoms prior to their diagnosis. This was demonstrated in a meta-analysis that included 21 mostly retrospective studies (one study was prospective) of women with epithelial ovarian cancer [9]. The proportion of women report symptoms differed by study design (7 percent were asymptomatic by patient interview or questionnaire; 23 percent according to medical records). This difference is likely due to recall bias in the patient report studies.

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Literature review current through: Nov 2017. | This topic last updated: Apr 14, 2017.
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  1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.
  2. Goff BA, Muntz HG. Screening and early diagnosis of ovarian cancer. Women's Health in Primary Care 2005; 8:262.
  3. Goff BA, Mandel L, Muntz HG, Melancon CH. Ovarian carcinoma diagnosis. Cancer 2000; 89:2068.
  4. Olson SH, Mignone L, Nakraseive C, et al. Symptoms of ovarian cancer. Obstet Gynecol 2001; 98:212.
  5. Vine MF, Ness RB, Calingaert B, et al. Types and duration of symptoms prior to diagnosis of invasive or borderline ovarian tumor. Gynecol Oncol 2001; 83:466.
  6. Yawn BP, Barrette BA, Wollan PC. Ovarian cancer: the neglected diagnosis. Mayo Clin Proc 2004; 79:1277.
  7. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA 2004; 291:2705.
  8. Goff BA, Mandel LS, Drescher CW, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer 2007; 109:221.
  9. Bankhead CR, Kehoe ST, Austoker J. Symptoms associated with diagnosis of ovarian cancer: a systematic review. BJOG 2005; 112:857.
  10. Smith LH, Morris CR, Yasmeen S, et al. Ovarian cancer: can we make the clinical diagnosis earlier? Cancer 2005; 104:1398.
  11. http://seer.cancer.gov/statfacts/html/ovary.html (Accessed on May 31, 2013).
  12. Hoskins WJ. Epithelial ovarian carcinoma: principles of primary surgery. Gynecol Oncol 1994; 55:S91.
  13. Hoskins WJ, McGuire WP, Brady MF, et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 1994; 170:974.
  14. Gilbert L, Basso O, Sampalis J, et al. Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project. Lancet Oncol 2012; 13:285.
  15. Ramirez PT, Frumovitz M, Wolf JK, Levenback C. Laparoscopic port-site metastases in patients with gynecological malignancies. Int J Gynecol Cancer 2004; 14:1070.
  16. Brown PO, Palmer C. The preclinical natural history of serous ovarian cancer: defining the target for early detection. PLoS Med 2009; 6:e1000114.
  17. Han LY, Karavasilis V, Hagen Tv, et al. Doubling time of serum CA125 is an independent prognostic factor for survival in patients with ovarian cancer relapsing after first-line chemotherapy. Eur J Cancer 2010; 46:1359.
  18. Bankhead CR, Collins C, Stokes-Lampard H, et al. Identifying symptoms of ovarian cancer: a qualitative and quantitative study. BJOG 2008; 115:1008.
  19. Hippisley-Cox J, Coupland C. Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm. BMJ 2011; 344:d8009.
  20. Rossing MA, Wicklund KG, Cushing-Haugen KL, Weiss NS. Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst 2010; 102:222.
  21. Cass I, Karlan BY. Ovarian cancer symptoms speak out--but what are they really saying? J Natl Cancer Inst 2010; 102:211.
  22. Andersen MR, Goff BA, Lowe KA, et al. Combining a symptoms index with CA 125 to improve detection of ovarian cancer. Cancer 2008; 113:484.
  23. Goff BA, Lowe KA, Kane JC, et al. Symptom triggered screening for ovarian cancer: a pilot study of feasibility and acceptability. Gynecol Oncol 2012; 124:230.
  24. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117:742.
  25. Redman C, Duffy S, Bromham N, et al. Recognition and initial management of ovarian cancer: summary of NICE guidance. BMJ 2011; 342:d2073.
  26. Morgan RJ Jr, Alvarez RD, Armstrong DK, et al. Epithelial ovarian cancer. J Natl Compr Canc Netw 2011; 9:82.
  27. http://www.wcn.org/articles/types_of_cancer/ovarian/symptoms/index.html (Accessed on May 26, 2011).
  28. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  29. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117:742.