Fatigue is one of the early signs of ovarian cancer.

Ovarian cancer often has no symptoms (or only very mild ones) until it begins to spread beyond the ovaries. Unfortunately, there is no effective way of screening for ovarian cancer at this time. The effective treatment of ovarian cancer will be significantly increased if researchers can develop a screening test that helps doctors identify ovarian cancer at its early stages. Several large studies are currently underway, but the results will not be available for several years.

Physical symptoms of ovarian cancer include:

• abdominal discomfort or pelvic pain
• bloating
• difficulty eating or feeling full quickly
• frequent urination
• fatigue
• backache
• nausea, indigestion, loss of appetite
• weight loss
• change in bowel habits
• gas
• pain during intercourse
• abnormal vaginal bleeding (rare)

These symptoms are associated with a variety of health concerns, many of which are not serious. However, any woman who experiences any combination of these symptoms for more than three weeks should contact her family doctor and consider having the following tests:

• a bimanual rectovaginal examination
• a transvaginal ultrasound
• a CA-125 blood test (postmenopausal women only)

A bimanual rectovaginal exam
A bimanual rectovaginal exam involves a doctor inserting one finger into the vagina and another into the rectum, to feel for any lumps around the ovaries.

Transvaginal ultrasound
An ultrasound uses sound waves to create a picture of the inside of the body. During a transvaginal ultrasound, a probe is placed inside the vagina to take 'pictures.' The images can be seen on a video monitor and may also be printed out.

A transvaginal ultrasound can help spot abnormal growths on the ovary, and if abnormalities are present, it may help to distinguish between a tumour and a cyst. The test is painless and can be completed very quickly. You do not need to drink water for this test.

CA-125 test
CA-125 is a protein which is normally found in the body, but which is often produced at higher levels by tumour cells. Most women with Stage-3 or Stage-4 ovarian cancer have elevated levels of CA-125. A blood test can measure your level of CA-125.

A CA-125 test has several limitations. It is not effective for detecting ovarian cancer in its early stages, as only 40 to 50 percent of women with Stage-1 ovarian cancer have elevated levels of CA-125. Another limitation is that many women who have elevated levels of CA-125 do not have ovarian cancer at all. Elevated CA-125 levels can also be caused by a number of other conditions, many of which are benign. These include endometriosis, pelvic inflammatory disease, fibroids, benign tumours, pregnancy and other conditions.

If abnormalities are found during any of these tests, further tests should be done, as none of these initial tests can prove you have cancer. To distinguish between a malignant growth and a benign tumour or cyst, followup diagnostic tests are needed.

If your doctor suspects that you may have ovarian cancer, ask for a referral to a gynecological oncologist.

• Diagnostic tests for ovarian cancer
• Staging ovarian cancer