Warning Signs of Ovarian Cancer: The Silent Killer

shutterstock_705697510 (1)
The teal awareness ribbon is a symbolic bow color for supporting patient with Ovarian Cancer, Polycystic Ovary Syndrome (PCOS) and Post Traumatic Stress Disorder (PTSD) Illness awareness.

The American Cancer Society (ACS) reports that ovarian cancer ranks fifth in cancer deaths among women, accounting for more fatalities than any other cancer of the female reproductive system.

The ACS estimates that in 2018, about 22,240 women will be diagnosed with a new case and 14,070 will die from ovarian cancer. On Long Island, from 2012 to 2014, the ovarian cancer incidence rate was 718 per 100,000 — a regional incidence rate of 16.4 during that time period, according to the New York State Department of Health.

While a relatively uncommon disease, “Ovarian cancer is the most lethal of the gynecological cancers and one of the most lethal malignancies overall,” says Dr. Michael Pearl, the Director of Women’s Cancer Services and Medical Director of Cancer Center Clinical Trials at Stony Brook University Hospital. “Anything we can do to increase public awareness is really important.”

Because September is National Ovarian Cancer Awareness Month, here are some tips for what to watch for:


Of the four types of ovarian cancer — germ cell, stromal cell, small cell and epithelial — epithelial, which develops on the ovary’s surface, is most common, explains Dr. Pearl.

Early symptoms may include nausea, diarrhea, pelvic pain, and changes in appetite. As the disease advances, symptoms may include chest pain, shortness of breath, bloating, vomiting, weight loss or gain, and difficulty with bladder or bowel functions.


Women who have chosen not to have children or are infertile are at increased risk, says Dr. Eva Chalas, chief of the Division of Gynecologic Oncology at NYU Winthrop Hospital. Obesity is linked to increased risk, as well as genetics and family history.

“On Long Island, we have a lot of women with the BRCA [BReast CAncer genes] mutation,” she says, noting the Ashkenazi Jewish population.

These genes typically suppress tumors, however, when they mutate, they can cause more harm. The ACS reports that women with a BRCA1 mutation have a 35 percent to 70 percent chance of developing ovarian cancer in their lifetime and women with BRCA2 mutations have a 10 percent to 30 percent risk of developing ovarian cancer by age 70.

“In the U.S., two-thirds of adult women are either overweight or obese, which has resulted in hazards to their health—cancer is one of them,” says Dr. Chalas. “Maintaining normal body weight and exercising regularly can minimize the risk of developing a number of cancers, including ovarian.”

There are no recommended screening tests to efficiently test for ovarian cancer, says Dr. Pearl.

The U.S. Preventive Services Task Force recommends against screening for ovarian cancer in asymptomatic women, determining that screening could result in harm, including false-positive test results and unnecessary surgical interventions. This applies to women with no symptoms who are not known to have a high-risk hereditary cancer syndrome.  


“Chemotherapy agents have improved in effectiveness and tolerability,” Dr. Pearl notes. “Surgery has gotten better.”

PARP inhibitors, which help repair DNA, are available to patients with BRCA mutations.

“Most institutions are now doing molecular testing of tumor cells…there are ongoing trials looking at immunotherapies, vaccines and other targeted therapies,” Dr. Chalas says. “Survival for ovarian cancer has improved but we still have a ways to go.”

Additional funds for research and treatment are desperately needed, the doctors say.

Women who are diagnosed with ovarian cancer must be treated by a gynecologic oncologist, asserts Drs. Pearl and Chalas. Comprehensive treatment by an expert will provide the best outcomes.   


“When a woman hears that she has ovarian cancer, it’s not surprising she’s absolutely devastated and frightened,” says Sharon Lerman, LCSW-R, OSW-C, Manager, Social Work – Oncology, Monter Cancer Center, Northwell Health Cancer Institute in Lake Success. “It’s very important to become educated about the illness, advocate for yourself and work with your medical team,” which can include doctor(s), nurses, loved ones, social worker, nutritionists, etc.

Learn what resources — physical, emotional, psychological and financial — will best meet the individual needs of patient and family, she says.