Doctors Warn Ovarian Cancer Can Mimic Stomach Problems, Delaying Diagnosis Until Advanced Stages

Ovarian cancer is often called a “silent threat” because early symptoms can be vague and easily mistaken for gastrointestinal problems, leading many patients to seek medical attention only after the disease has progressed. Thai medical experts are urging women to recognise persistent warning signs and understand their genetic risk.

BANGKOK -  Medical experts in Thailand are warning women to pay closer attention to persistent abdominal and digestive symptoms that could be linked to ovarian cancer, a disease that is frequently diagnosed only after it has reached an advanced stage.

Ovarian cancer can develop from cells in the ovaries, fallopian tubes or peritoneum and includes several pathological types. Epithelial ovarian cancer, which is more commonly found among postmenopausal women, accounts for around 90% of cases, while other forms such as germ cell tumours are more frequently diagnosed in children and younger women.

One of the major challenges is that ovarian cancer often produces few or no clear warning signs during its early stages.

When symptoms do appear, they may resemble common gastrointestinal conditions, including bloating, indigestion, feeling full quickly, persistent lower abdominal discomfort or an unexplained increase in abdominal size due to fluid accumulation.

Because these symptoms can easily be mistaken for stomach or digestive problems, many patients delay seeking specialist care.

According to Thailand’s Department of Medical Services, around 70% of ovarian cancer patients are diagnosed when the disease has already progressed to Stage III or Stage IV, when cancer cells may have spread throughout the pelvis and abdominal cavity.

Detection at an advanced stage is associated with a substantially lower five-year survival rate compared with cases diagnosed while the cancer remains confined to the ovary.

Reproductive History and Genetics Can Influence Risk

Medical experts say several reproductive and genetic factors can influence a woman’s risk of developing ovarian cancer.

Women who experience a greater number of ovulatory cycles during their lifetime may face a higher risk. This includes those who begin menstruation before the age of 12, experience menopause after the age of 52 or have never been pregnant.

The source information indicates that each additional year of ovulation is associated with an estimated 7% increase in risk.

By contrast, having at least one pregnancy, using oral contraceptives or breastfeeding has been associated with a reduction in ovarian cancer risk of approximately 30–60%.

Family history is another important consideration.

Women with a first-degree relative, such as a mother or sister, who has had ovarian cancer may face an estimated risk of around 5%, while those with an affected second-degree relative, such as a grandmother or aunt, may have a risk of around 3.5%.

Inherited cancer syndromes can increase risk further.

Women carrying genetic mutations associated with Hereditary Breast and Ovarian Cancer Syndrome, particularly BRCA1 or BRCA2 mutations, may have substantially higher lifetime risks of ovarian cancer.

Hereditary nonpolyposis colorectal cancer syndromes and certain other DNA repair gene mutations may also increase risk, while endometriosis has been linked to a higher risk of some epithelial ovarian cancer subtypes.

Genetic Testing Increasingly Important in Treatment Decisions

Genetic assessment has become an increasingly important part of ovarian cancer management, particularly for patients with epithelial ovarian cancer and those with family histories suggesting hereditary cancer risk.

Testing may involve a blood test to identify inherited mutations that can be passed through families, or analysis of tumour tissue to detect genetic changes within the cancer itself.

Doctors may also test for Homologous Recombination Deficiency, or HRD, which can provide information useful for selecting specific cancer treatments.

Patients found to carry pathogenic mutations in BRCA1 or BRCA2 may benefit from targeted medicines known as PARP inhibitors, depending on their clinical circumstances.

Multi-gene panel testing can also examine genes including TP53, PALB2, ATM, BRIP1, RAD51C, RAD51D and mismatch repair genes.

For women with certain high-risk inherited mutations who have completed childbearing, doctors may also consider risk-reducing surgery involving removal of both fallopian tubes and ovaries.

No Widely Accepted Screening Test for General Population

Despite advances in diagnosis and treatment, ovarian cancer remains particularly difficult to detect early because there is currently no established screening method considered suitable for routine population-wide screening.

Pelvic examinations, the CA-125 tumour marker blood test and pelvic ultrasound have not been established as effective general screening tools for detecting ovarian cancer in women without symptoms or specific high-risk factors.

Experts therefore emphasise the importance of recognising persistent or unusual symptoms and seeking medical evaluation rather than relying on routine screening alone.

Women experiencing persistent bloating, abdominal discomfort, early satiety or unexplained enlargement of the abdomen should consider consulting a healthcare professional, particularly if symptoms are new, recurrent or worsening.

Treatment Becoming More Personalised

Treatment for epithelial ovarian cancer typically combines several approaches depending on the stage of disease, tumour characteristics and the patient’s overall health.

Major treatment options include primary surgery, chemotherapy and targeted therapy, with decisions generally made by gynaecologic oncologists and multidisciplinary cancer teams.

Advances in genetic and molecular testing are increasingly allowing doctors to personalise treatment according to the biological characteristics of individual tumours.

This approach can help identify patients who may benefit from targeted medicines while also helping families understand whether they may carry inherited cancer risks.

Although ovarian cancer remains challenging because of its subtle early symptoms and the lack of an effective population screening programme, medical experts stress that greater awareness can help women respond to warning signs earlier.

Recognising persistent changes in the body, understanding family history and receiving appropriate genetic counselling when indicated may help patients enter the diagnostic and treatment process sooner and provide doctors with more options for personalised care.

 

Source : Thai Health Promotion Foundation