DEAR MAYO CLINIC: I have a friend who was diagnosed with ovarian cancer, but she didn't have any obvious symptoms. What are some signs or symptoms women should pay attention to and get checked out? 

ANSWER: Unfortunately, ovarian cancer can be a difficult-to-detect disease early on because its symptoms often are vague and easily mistaken for common digestive, urinary or gynecologic problems. Many of the symptoms are things women experience from time to time. 

The key is to recognize when something has changed. Occasional indigestion or bloating usually isn't a reason for alarm. But when a symptom is new, different from what's normal for you or doesn't go away, it's important to pay attention to it and have a talk with your healthcare team. 

Five signs that can be easily overlooked and brought up when you see your healthcare team: 

1. Persistent heartburn or indigestion

Heartburn is common, so it's easy to reach for an over-the-counter antacid and move on. But persistent indigestion sometimes can be associated with ovarian cancer. In the past, ovarian cancer symptoms were described as being "hidden" by prolonged antacid use because women might treat what seems like routine heartburn for months without investigating why it continues. That doesn't mean heartburn is usually cancer. It means persistent digestive symptoms that don't settle down deserve attention rather than repeated self-treatment. 

2. Bloating or abdominal fullness

Most people experience bloating occasionally. With ovarian cancer, however, a woman may notice ongoing bloating or a sense of fullness in her abdomen that wasn't there before. The sensation may be difficult to describe. Because this symptom can develop gradually, it may be easy to dismiss.  

3. Feeling full after eating only a small amount

A woman may sit down for a meal and find that after only a few bites, she feels as though she's eaten enough. It could be a concern if this happens repeatedly and represents a change in appetite or eating pattern. 

4. Changes in urination

Ovarian cancer also can cause symptoms that seem more likely to be related to the bladder. A woman may need to urinate more frequently or feel as though her bladder hasn't completely emptied after going to the bathroom. Urinary changes can have many causes, but new or ongoing changes deserve attention. 

5. Changes in bowel habits

A woman who has been fairly regular throughout her life may suddenly notice more constipation, occasional diarrhea or another significant change in bowel habits. As with the other symptoms, an isolated episode generally isn't a concern. 

Changes in menstrual cycles also shouldn't automatically be dismissed. Irregular cycles can be common during perimenopause and menopause. While menstrual changes are more commonly associated with uterine, endometrial or cervical cancers, ovarian cancer also can be associated with changes such as more frequent or heavier cycles or increased menstrual pain. 

With ovarian cancer, awareness is particularly important. By the time symptoms become noticeable, the cancer may no longer be at an early stage. There also isn't a routine ovarian cancer screening recommendation for the general population comparable to mammograms for breast cancer or screening for colorectal cancer.  

Tests such as the CA-125 blood test and pelvic ultrasound can be useful in certain situations, including for some people at higher risk, but these tests have limitations and can produce false-positive or false-negative results. 

Women are at higher risk if they: 

• Are older. 

• Have inherited gene changes, including BRCA1 and BRCA2. 

• Have several other gene changes known to increase the risk of ovarian cancer, such as those associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D. 

• Have a family history of ovarian cancer.  

• Are overweight or obese.  

• Are undergoing postmenopausal hormone replacement therapy.  

• Have endometriosis. 

• Began menstruation early or late.  

• Have never been pregnant. 

The most important takeaway is to know what's normal for your body. Digestive discomfort, bloating and urinary changes are common and usually aren't caused by ovarian cancer. But if you have symptoms that are new, persistent, distinctly different from your usual pattern or don't feel right, talk with your healthcare team. An evaluation can help determine the cause and whether additional testing is needed. 

Sandeep Basu, M.D., Breast Cancer Care, Hematology and Oncology, Mayo Clinic Health System, Eau Claire and Menomonie, Wisconsin 

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