Ovarian cancer symptoms can be subtle and easy to miss, doctors say, so attention to small but persistent changes in digestion, pelvic pain, or bathroom habits may help with earlier diagnosis.
What to look for, the B.E.A.T. warning signs
Obstetrics and gynecology specialist Choi Jyu-ga (蔡汝嘉) said ovarian cancer often begins without clear signs, which is why it is sometimes called a silent killer. She recommends watching for four common clusters of symptoms summarized by the acronym B.E.A.T., which stands for bloating, eating difficulties, abdominal pain, and toilet changes.
Gastrointestinal symptoms: Tumors in the ovary can press on nearby ligaments or irritate the abdominal cavity, and fluid build-up called ascites can cause persistent bloating, indigestion, and decreased appetite, Dr. Choi said.
Pelvic and lower back pain: When an ovarian tumor invades surrounding tissue or causes adhesions, patients may feel a continuous dull ache in the lower abdomen or lower back that does not improve with rest or massage, she said.
Changes in bathroom habits: Increased urinary frequency or urgency, and altered bowel habits, can be part of the symptom picture and should prompt evaluation if they are new and persistent.
Dr. Choi noted that most ovarian cancer patients do not have menstrual changes unless the tumor secretes hormones. Tumors that produce estrogen may cause early puberty, irregular menstruation, or postmenopausal bleeding. Rare germ cell tumors that secrete androgens can cause mild masculinizing features, she said.
Who is at higher risk
Dr. Choi advised that certain groups should be especially vigilant and keep up with regular gynecologic care. She listed five higher-risk profiles:
- Age 45 and older, especially postmenopausal women.
- First-degree relatives, such as a mother or sister, with ovarian or breast cancer, particularly when associated with BRCA1 or BRCA2 gene mutations.
- Never having given birth, long-term infertility, or menopause after age 55.
- A history of endometriosis or a prior diagnosis of breast cancer.
Women in these groups should discuss individualized surveillance with their gynecologist, Dr. Choi said.
Screening and regular gynecologic checks
There is no universally accepted, effective population screening test for ovarian cancer, Dr. Choi said, but maintaining good health habits and having regular gynecologic examinations are important for early detection.
Pelvic ultrasound: Transvaginal or pelvic ultrasound is noninvasive and does not use radiation. Dr. Choi recommends that women, especially those at higher risk, consider a pelvic ultrasound every one to two years. If a physician suspects a pelvic mass, they may also check the blood level of the cancer biomarker cancer antigen 125, or CA125.
Reduce risk factors: Avoid prolonged unopposed estrogen therapy and work to control weight and chronic inflammation, Dr. Choi advised.
Treatment approach by stage
Before treatment, physicians usually use MRI or PET-CT imaging to estimate the cancer stage and plan surgery. Final, precise staging is determined by pathological examination of tissue removed during surgery, Dr. Choi said.
Surgery is the primary treatment for ovarian cancer. The operation can remove both ovaries, the uterus, fallopian tubes, and the omentum, and may include nearby lymph nodes.
Early-stage patients are often treated with surgery alone or surgery followed by chemotherapy. Younger patients who wish to preserve fertility may be able to keep one ovary and the uterus, with close follow-up and adjuvant chemotherapy, Dr. Choi said.
Advanced cases that have spread typically require removal of all visibly involved organs followed by systemic chemotherapy. If a patient cannot tolerate aggressive therapy, palliative care is an option. Dr. Choi also noted that some clinical studies have shown immunotherapy can help a subset of advanced ovarian cancers, and patients with BRCA mutations may receive PARP inhibitors after surgery to reduce the chance of recurrence.
Prognosis and the value of early detection
Early detection matters. According to the Hospital Authority’s 2023 Hong Kong cancer statistics overview, early stage I ovarian cancer has a cure rate of about 90 percent. When diagnosis is delayed and disease reaches stage III or IV, the five-year survival rate falls to roughly 30 percent to 10 percent, the report shows.
Dr. Choi reiterated that women should tell their gynecologist if they experience multiple B.E.A.T. symptoms or any persistent pelvic or abdominal changes. Timely evaluation and treatment significantly improve outcomes, she said.
For more information, contact obstetrics and gynecology specialist Choi Jyu-ga (蔡汝嘉). She provides consultation, diagnosis, and surgical and medical treatment for precancerous conditions and gynecologic cancers.
Qualifications and appointments: Bachelor of Medicine and Bachelor of Surgery, The University of Hong Kong; Fellow, Royal College of Obstetricians and Gynaecologists; Fellow, Hong Kong College of Obstetricians and Gynaecologists; Fellow, Hong Kong Academy of Medicine, specialty in obstetrics and gynecology; Certificate in Gynecologic Oncology from the Hong Kong College of Obstetricians and Gynaecologists.
Source: Hospital Authority 2023 Hong Kong cancer statistics overview, and interview with Dr. Choi Jyu-ga.
