Ovarian cancer is cancer that develops in one of the two ovaries, small glands in the female reproductive system. Ovaries are responsible for producing ova, or eggs. They also produce hormones, like estrogen and progesterone.

Epithelial ovarian cancer is the more common type. It doesn’t always develop in the ovaries though, in spite of its name. Ovarian cancer also arises in related organs, such as the fallopian tubes and peritoneum, the tissue that protects organs in the abdomen.

In some instances, cells in the ovaries, on the fallopian tubes, or on the peritoneum may begin to grow in an unexpected way and multiply out of control.

These cells can form a tumor, and if the tumor is not found or if it’s left untreated, it can spread (metastasize) to other parts of the body.

This article will examine why ovarian cancer is hard to detect and what can be done if you think you may have symptoms. It will also look at what goes into an ovarian cancer diagnosis.

Doctors often don’t find ovarian cancer until it has progressed to an advanced stage. In fact, only 20 percent of ovarian cancer is diagnosed in early stages.

Early stage tumors are easier to treat and even cure. However, many ovarian cancers are not found until stages 3 and 4, at which point the cancer has spread within the pelvic region — and sometimes beyond.

Late detection puts many people diagnosed with ovarian cancer at a disadvantage because of how quickly it has spread by this time.

There are several reasons early ovarian cancer detection and diagnosis isn’t more common. These include:

Vague symptoms

Ovarian cancer used to be called a “silent” killer. This is because the early symptoms of this cancer can be difficult to detect.

But ovarian cancer is not silent. Symptoms may occur in the early stages and either be ignored or believed to be related to something else.

A 2012 study explained the symptoms of ovarian cancer as follows:

  • abdominal bloating
  • pressure or pain in the abdomen
  • feeling unusally full after a meal
  • difficulty eating or feeling full quickly
  • urination changes (including an increase in urination or feeling the urge to urinate frequently)
  • back pain
  • menstruation changes
  • painful intercourse

If any of these symptoms are persistent or you experience them for more than 12 times per month, make an appointment with your doctor so you can get to the bottom of what’s happening in your body.

No screening test

A colonoscopy can detect colon cancer. A Pap test can detect cervical cancer. But ovarian cancer doesn’t have its own screening test.

Researchers are working on possible screening tests, but for now, there’s no single test being used to detect ovarian cancer.

A 2018 guideline from the U.S. Preventive Services Task Force stated that the risks of possible screening tests are too great to make a case for the potential benefits.

Instead, doctors mostly rely on physical exams and patients’ self-reporting to find these cancers.

Pelvic exams rarely detect cancer in the early stages

Ovaries are positioned deep inside the abdominal cavity. This can make it difficult to feel a lump or enlarged area. Sometimes, doctors can’t even detect an abnormality during a pelvic exam.

Imaging tests are frequently used to find tumors. Typically, a doctor doesn’t order these tests without suspicion of a tumor, making it even more important not to ignore symptoms or changes in your body.

Just as there is no screening test for ovarian cancer, there is no single test that can diagnose ovarian cancer, either.

Instead, a healthcare professional will rely on several tests to determine if a tumor is growing within an ovary. If a tumor is found, other tests may be done to determine whether it’s cancerous.

The diagnostic tests most often used include:

  • Pelvic exam. During a pelvic exam, a healthcare professional will feel your abdomen and pelvic area for signs of enlarged ovaries.
  • Transvaginal ultrasound (TVU). During a TVU, a healthcare professional places a small instrument inside the vagina. It sends back images of the ovaries, fallopian tubes, and uterus. This test can only see growths; it can’t determine if they’re cancerous.
  • Blood test. Cancer antigen 125 (or CA-125) is biomarker frequently found in high levels in people with ovarian or fallopian tube cancer. However, other health conditions can cause elevated CA-125 levels, so it is also not a definitive test.
  • Surgical staging. A surgeon will remove tumor tissue in order to take a biopsy of the tissue’s tumor. The biopsy determines if the tumor is cancerous. This biopsy is often done during surgery to remove all visible cancer.

If these tests suggest ovarian cancer may be present — and if a biopsy confirms the tumor is cancerous — your doctor may also order tests to determine if the cancer has spread beyond the ovaries.

These tests may include a:

  • colonoscopy
  • chest X-ray
  • positron emission tomography (PET) scan

A healthcare professional may want to review your individual risk factors for ovarian cancer. These factors increase a person’s risk for developing ovarian cancer, though they do not guarantee a person will develop it.

Risk factors include:

  • a family history of ovarian cancer
  • a personal history of breast, uterine, or colorectal cancer
  • the presence of genetic mutations, such as BRCA1 and BRCA2, associated with ovarian cancer
  • a history of fertility drug or hormone therapy usage
  • not having biological children
  • endometriosis
  • age (it’s rare that women under 40 develop ovarian cancer)
  • obesity

Likewise, people with these risk factors may have more regular exams to look for signs of enlarged ovaries or other symptoms of ovarian cancer.

If doctors screen regularly for skin cancer, prostate cancer, colon cancer, breast cancer, and more, you might think it makes sense to conduct regular screening for ovarian cancer. But there’s a reason ovarian cancer screening isn’t standard.

In fact, 2016 research out of the University of Pennsylvania School of Medicine found that people with an average risk of ovarian cancer who got a TVU and a CA-125 blood test as an ovarian cancer screening ended up having more testing and sometimes even unnecessary surgeries.

The additional screening and testing did not reduce the number of deaths caused by ovarian cancer.

Genetic testing has some value in determining a person’s predisposition for ovarian cancer. People with the BRCA1 and BRCA 2 gene mutations or other gene mutations are at a higher risk for the cancer.

However, not everyone with gene mutations will develop the cancer. Screening can be expensive, too, which also helps explain why regular screening for ovarian cancer isn’t more commonplace.

Instead, genetic counseling and testing are typically suggested after an ovarian cancer diagnosis is made. This information can help your cancer care team select better treatments and understand your risk factors for other health complications.

If ovarian cancer is suspected, your doctor should refer you to a gynecologic oncologist (GO). These specialists diagnose, analyze, and treat ovarian cancers.

Research from 2021 emphasizes the importance of treatment by a GO to increase overall survival among women with ovarian cancer.

The oncologist may request additional testing. This can help them determine if a tumor is present and if it’s cancerous. It can also help them see if the cancer has spread beyond the ovary.

If ovarian cancer is found, you will likely begin treatment right away. Surgery is usually recommended. During this surgery, the oncologist will likely remove the uterus, ovaries, and fallopian tubes.

Chemotherapy is also a common treatment. Additional surgery may be needed to remove lymph nodes and tissues in the pelvis and abdomen.

Early stage ovarian cancer can be difficult to detect, but it’s not impossible. Early detection is vital for successful treatment. There is no regular screening for ovarian cancer, but doctors can run tests to help properly diagnose what’s happening in your body.

Pay attention to symptoms or changes in your body, and make an appointment with a GO, who can help get to the root of what you’re experiencing.