Ovarian cancer is sometimes referred to as "silent killer" and has the reputation of not causing illness or discomfort until advanced stages of the disease. Retrospective surveys, however, have shown that up to 80% of all patients do experience cancer-related symptoms [1]. Unfortunately though, EOC-associated symptoms are frequently seen in the general population, they are explained by common gastrointestinal, genitourinary, and gynecological disorders, and are thus often ignored by patients and physicians [2]. Characteristic yet unspecific symptoms of EOC comprise abdominal or pelvic pain, early satiety, bloating, urinary urgency and pollakisuria [3]. Women may also present with a palpable abdominal mass.

Both hematogenic and lymphogenic spread are regularly observed in EOC patients, but it is even more likely that tumor cells are shed into the peritoneal cavity and implant on the omentum, visceral or parietal peritoneum. Depending on their location, metastases may cause additional symptoms. Advanced-stage EOC may also be associated with constitutional symptoms like fever, night sweats and chills, loss of appetite and weight.

• Fatigue

  Grade 3 fatigue occurred in both patients, resulting in a dose reduction of thalidomide, with toxicity otherwise acceptable. One patient had a partial response, while the second patient had stable disease. [ncbi.nlm.nih.gov]

  People with ovarian cancer may also experience other symptoms, such as back pain, pain during sex, constant fatigue and nausea. left Created with Sketch. right Created with Sketch. [independent.co.uk]

  low levels of white blood cells (neutropenia or leukopenia), heart palpitations, nausea, constipation, vomiting, abdominal pain/swelling (distention), inflammation of the mucous membranes (mucositis), diarrhea, indigestion (dyspepsia), dry mouth, fatigue [fda.gov]

  The most common adverse events were diarrhea, nausea, and fatigue [ 43 ]. [intechopen.com]

• Virilization

  A common symptom is known as virilism, which can include: infrequent menstrual periods menstrual periods after menopause appearance of facial hair a hoarse voice [ovariancanada.org]

  Consequently, depending on the specific histology produced, these tumours can cause virilization in women and feminization in men. Tumour types in order of prevalence[edit] Granulosa cell tumour. [en.wikipedia.org]

• Lymphadenopathy

  Palpation of the supraclavicular, axillary, and inguinal lymph nodes may reveal lymphadenopathy, which can be indicative of metastasis. [en.wikipedia.org]

• Pleural Effusion

  Verheul et al. in their study, observed that malignant ascites and pleural effusion in cancer patients contained high levels of active VEGF-A and hypothesized that blocking VEGF-A expression may benefit patients with recurrent ascites or pleural effusion [omicsonline.org]

  effusion or EOC with distant metastasis other than peritoneal metastasis In order to realize a complete tumor staging, all features considered in the FIGO staging system have to be checked. [symptoma.com]

  T3c N0/1 IV Distant metastasis excluding peritoneal metastasis TX NX M1 IVA Pleural effusion with positive cytology TX NX M1 IVB Metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of abdominal cavity) or parenchymal [bccancer.bc.ca]

  The presence of pleural effusion does not necessarily indicate disease in the chest, and malignancy can be diagnosed only cytologically. [medscape.com]

• Dyspnea

  […] urinary tract infection, liver problems (AST/ALT elevation), muscle pain (myalgia), back pain, joint pain (arthralgia), headache, dizziness, unusual taste sensation (dysgeusia), insomnia, anxiety, cold-like symptoms (nasopharyngitis), trouble breathing (dyspnea [fda.gov]

  There was more toxicity in the form of dyspnea (20% vs. 8%) in the aflibercept arm and also intestinal perforation (3 patients vs. 1). However, there was more fatigue or asthenia (13% vs. 44%) and more dehydration (10% vs. 12%) with placebo [ 47 ]. [intechopen.com]

• Nausea

  A 60-year-old woman with stage Illc epithelial ovarian cancer developed neutropenic fever, abdominal pain, severe diarrhoea, nausea, vomiting and oral mucositis one week after the first postoperative cycle of paclitaxel (175 mg/m2 3-hour infusion) plus [ncbi.nlm.nih.gov]

  Symptoms include: Pelvic pain or pressure, Pain with intercourse, Abdominal swelling and bloating, Urinary frequency, Constipation, Ascites (collection of fluid in the abdomen), Loss of appetite, Feeling full after eating little, Gas and/or diarrhea, Nausea [emedicinehealth.com]

  It is important to proactively manage these events to avoid prolonged or more severe events of nausea/vomiting which have the potential to lead to complications such as dehydration or hospitalization. [finance.yahoo.com]

  People with ovarian cancer may also experience other symptoms, such as back pain, pain during sex, constant fatigue and nausea. left Created with Sketch. right Created with Sketch. [independent.co.uk]

• Constipation

  A case of strumal carcinoid of the ovary with contralateral clear cell adenocarcinoma of the ovary discovered with a complaint of constipation is described. Constipation was dramatically improved by resectioning the tumor. [ncbi.nlm.nih.gov]

  Symptoms include: Pelvic pain or pressure, Pain with intercourse, Abdominal swelling and bloating, Urinary frequency, Constipation, Ascites (collection of fluid in the abdomen), Loss of appetite, Feeling full after eating little, Gas and/or diarrhea, [emedicinehealth.com]

  Changes in bowel habits, such as constipation. Low-Grade Serous Carcinomas (LGSC) Low-grade serous carcinomas (LGSC) are more similar to serous tumors of low malignant potential and are quite distinct from high-grade serous carcinomas. [mnovarian.org]

  By spring, episodes of constipation, an expanding waistline and serious fatigue were emerging, but I rationalized them away. Everyone is constipated sometimes, I must have gained weight and women in my family tend to have bellies. [sharecancersupport.org]

  These signs include: Clear, white or bloody vaginal discharge Feeling of pressure in the abdomen or pelvis Gas, bloating or constipation Heavy or irregular vaginal bleeding Lump in the pelvic area Pain or swelling in the abdomen or pelvic area If you [loyolamedicine.org]

• Abdominal Pain

  For the second cycle the dose of paclitaxel was reduced by 20%, but nine days later the patient again developed severe neutropenia with fever, abdominal colicky pain, diarrhoea and vomiting. [ncbi.nlm.nih.gov]

  Case Description A 34-year-old woman during the 37th week of her first gestation called her obstetrician because she felt an acute abdominal pain. [scielo.br]

  The most common symptoms of ovarian cancer are: Abdominal pain or bloating. Early satiety or feeling full quickly. Urinary urgency or frequency. Changes in bowel habits, such as constipation. [mnovarian.org]

  pain/swelling (distention), inflammation of the mucous membranes (mucositis), diarrhea, indigestion (dyspepsia), dry mouth, fatigue, decreased appetite, urinary tract infection, liver problems (AST/ALT elevation), muscle pain (myalgia), back pain, joint [fda.gov]

  If the stromal tumor starts to bleed, it can cause sudden, severe abdominal pain. [cancer.org]

• Diarrhea

  Symptoms include: Pelvic pain or pressure, Pain with intercourse, Abdominal swelling and bloating, Urinary frequency, Constipation, Ascites (collection of fluid in the abdomen), Loss of appetite, Feeling full after eating little, Gas and/or diarrhea, [emedicinehealth.com]

  […] low levels of blood platelets (thrombocytopenia), low levels of white blood cells (neutropenia or leukopenia), heart palpitations, nausea, constipation, vomiting, abdominal pain/swelling (distention), inflammation of the mucous membranes (mucositis), diarrhea [fda.gov]

  The most common adverse events were diarrhea, nausea, and fatigue [ 43 ]. [intechopen.com]

  The safety profile for the overall pooled population was consistent with previously reported data, with the most common adverse events including diarrhea, fatigue, nausea and blurred vision; however, these were low grade and well-managed. [curetoday.com]

• Loss of Appetite

  Symptoms include: Pelvic pain or pressure, Pain with intercourse, Abdominal swelling and bloating, Urinary frequency, Constipation, Ascites (collection of fluid in the abdomen), Loss of appetite, Feeling full after eating little, Gas and/or diarrhea, [emedicinehealth.com]

  The most common symptoms of ovarian cancer include experiencing a swollen stomach, discomfort in the tummy or pelvic area, feeling continually bloated, an increased need to urinate, a loss of appetite or becoming full from food quickly, the NHS explains [independent.co.uk]

  Side effects can include: nausea, vomiting diarrhea hair loss loss of appetite mouth sores anemia infections, because the white blood cell count is low The damaged healthy cells normally repair themselves rapidly after treatment is over, and the side [medicalnewstoday.com]

  Signs and symptoms of ovarian cancer recurrence may include: Persistent abdominal bloating, indigestion or nausea Changes in appetite, typically a loss of appetite or feeling full sooner Pressure in the pelvis or lower back Urge to urinate more frequently [cancercenter.com]

• Back Pain

  People with ovarian cancer may also experience other symptoms, such as back pain, pain during sex, constant fatigue and nausea. left Created with Sketch. right Created with Sketch. [independent.co.uk]

  /swelling (distention), inflammation of the mucous membranes (mucositis), diarrhea, indigestion (dyspepsia), dry mouth, fatigue, decreased appetite, urinary tract infection, liver problems (AST/ALT elevation), muscle pain (myalgia), back pain, joint pain [fda.gov]

  Early symptoms of ovarian cancer may include : pain in the pelvis, the lower abdomen, or the lower part of the body back pain indigestion or heartburn feeling full rapidly when eating more frequent and urgent urination pain during sexual intercourse changes [medicalnewstoday.com]

  […] constipation back pain menstrual irregularities painful intercourse dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles) These symptoms may occur for any number of reasons. [healthline.com]

• Hirsutism

  Other common symptoms include hirsutism, abdominal pain, virilization, and an adnexal mass.[22] Children[edit] In adolescents or children with ovarian tumors, symptoms can include severe abdominal pain, irritation of the peritoneum, or bleeding.[23] Symptoms [en.wikipedia.org]

• Withdrawn

  The patient was withdrawn from the study if there was more than a 30-day delay in the administration of the treatment or if more than two dose reductions were required. [intechopen.com]

  They included data from a trial by Melis 2016, but this study has subsequently been withdrawn from publication calling into question its validity. [cochranelibrary.com]

• Vaginal Bleeding

  These signs include: Clear, white or bloody vaginal discharge Feeling of pressure in the abdomen or pelvis Gas, bloating or constipation Heavy or irregular vaginal bleeding Lump in the pelvic area Pain or swelling in the abdomen or pelvic area If you [loyolamedicine.org]

  In both groups, the vaginal bleeding is due to oestrogen secreted by the tumour. In older women, treatment is total abdominal hysterectomy and removal of both ovaries. [en.wikipedia.org]

  The most common symptom of these tumors is abnormal vaginal bleeding. This happens because many of these tumors produce female hormones (estrogen). These hormones can cause vaginal bleeding (like a period) to start again after menopause. [cancer.org]

  Because sex-cord stromal tumors make an overabundant supply of estrogen, they often cause abnormal vaginal bleeding. Subtypes of sex cord-stromal tumors include granulosa cell tumors, granulosa-theca tumors and Sertoli-Leydig tumors. [cancercenter.com]

• Adnexal Mass

  Clinicians are advised to thoroughly investigate adnexal masses in this patient population. [ncbi.nlm.nih.gov]

  Discrimination between benign and malignant adnexal masses by specialist ultrasound examination versus serum CA-125. J Natl Cancer Inst. 2007;99(22):1706-1714. Chi D. [gotoper.com]

  The Adnexal Mass and Early Ovarian Cancer. Clinical Gynecologic Oncology, 7thed: 283-312, 2007. 3-Berrino F; De Angelis R; Sant M; Rosso S; Lasota MB; Coebergh JW. and Santaquilani M. [scla.org.sy]

  Management of adnexal masses. Obstet Gynecol. 2007 Jul. 110 (1):201-14. [Medline]. Suh-Burgmann E, Kinney W. Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses. Am J Obstet Gynecol. 2015 Dec. 213 (6):816.e1-4. [medscape.com]

• Pelvic Pain

  Pelvic and perineal pain Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women. Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. [en.wikipedia.org]

  Symptoms include: Pelvic pain or pressure, Pain with intercourse, Abdominal swelling and bloating, Urinary frequency, Constipation, Ascites (collection of fluid in the abdomen), Loss of appetite, Feeling full after eating little, Gas and/or diarrhea, [emedicinehealth.com]

  Characteristic yet unspecific symptoms of EOC comprise abdominal or pelvic pain, early satiety, bloating, urinary urgency and pollakisuria. Women may also present with a palpable abdominal mass. [symptoma.com]

  Symptoms Pelvic pain can be a sign of ovarian cancer. Most ovarian cancers start in the epithelium, or outer lining, of the ovary. In the early stages, there may be few or no symptoms. [medicalnewstoday.com]

  Other symptoms such as bloating and pelvic pain are often confusing and fail to catch the clinician’s attention Even the increase in CA-125 levels is considered highly non-specific in recent times and is used to assess response to treatment. [omicsonline.org]

• Vaginal Discharge

  These signs include: Clear, white or bloody vaginal discharge Feeling of pressure in the abdomen or pelvis Gas, bloating or constipation Heavy or irregular vaginal bleeding Lump in the pelvic area Pain or swelling in the abdomen or pelvic area If you [loyolamedicine.org]

  Vaginal bleeding that is heavy or irregular, especially after menopause. Vaginal discharge that is clear, white, or colored with blood. A lump in the pelvic area. Gastrointestinal problems, such as gas, bloating, or constipation. [my.clevelandclinic.org]

• Urinary Urgency

  Urinary urgency or frequency. Changes in bowel habits, such as constipation. [mnovarian.org]

  Characteristic yet unspecific symptoms of EOC comprise abdominal or pelvic pain, early satiety, bloating, urinary urgency and pollakisuria. Women may also present with a palpable abdominal mass. [symptoma.com]

Increased serum concentrations of tumor marker cancer antigen 125 may raise a suspicion of malignancy, but should not be considered an exclusion criterion for ovarian cancer. Indeed, diagnostic imaging is still the most important tool for EOC diagnosis. Imaging studies may either be carried out in symptomatic women or in the scope of surveillance programs, and they may provide valuable hints on the presence of an abdominal neoplasm. Sonography, computed tomography, and magnetic resonance imaging are usually employed to this end. Notwithstanding the usefulness of these techniques, they may lack sensitivity for the detection of early-stage EOC [4]. Concerning characteristic findings, ovarian malignancies often appear as cyst-bearing, heterogeneous lesions [1].

Tissue samples have to be obtained in order to determine cellular origin, grade and histotype of the tumor. There are four main histotypes of EOC, namely serous, endometrioid, mucinous, and clear cell EOC. They differ with regard to their macroscopic and microscopic appearance, their gene expression, growth behavior and response to therapy. It is beyond the scope of this article to describe the histotypes of EOC in detail and the interested reader is referred to excellent literature available on this topic [5] [6]. Briefly, the following features are characteristic of serous, endometrioid, mucinous, and clear cell EOC [5] [6]:

• Serous carcinoma is the most common histotype of EOC; it resembles the epithelium lining the Fallopian tube. In most cases, both ovaries are affected at the time of diagnosis. The tumor comprises solid parts, cystic lesions, necrotic foci and hemorrhages. Papillary architecture may be observed under the microscope, with papillae being lined by stratified epithelium of the serous type. Ciliated cells are rare. Papillae are separated by slit-like invaginations. Tumor cells frequently contain psammoma bodies. Mitotic figures and nuclear atypia are prominent in high-grade serous carcinomas.
• Endometrioid tumors account for 10-20% of EOC cases. They consist of epithelial and stromal elements that remind of the endometrium. These tumors usually contain cysts filled with dark brown fluid.
• Mucinous carcinoma consists of irregular glands and cysts lined by stratified epithelium composed of cells with abundant intracytoplasmic mucin and basal nuclei. There may be goblet cells and different types of endocrine cells, but contrary to benign mucinous cystadenoma, malignancies don't usually resemble the endocervical or intestinal epithelium. Of note, mucinous tumors may consist of benign, borderline, and malignant neoplastic tissue.
• Clear cell EOC is characterized by polygonal clear cells with abundant cytoplasmic glycogen and eccentric nuclei, and hobnail cells with protruding nuclei. Clear cell EOC is particularly common in women suffering from endometriosis.

With regard to EOC staging, the so-called FIGO staging system is generally applied. This system considers the following tumor stages [7] [8]:

• Stage 0: carcinoma in situ
• Stages 1A, 1B, 1C: tumor limited to one or both tubes, possibly penetrating the serosal surface, possibly surgical spill, capsule ruptured before surgery, tumor on ovarian surface, or presence of malignant cells in ascites or peritoneal washings
• Stages 2A, 2B: EOC with pelvic extension, metastases in ovaries, uterus and/or other pelvic structures
• Stages 3A, 3B, 3C: EOC with microscopic or macroscopic peritoneal implants outside the pelvis and/or positive regional lymph nodes
• Stage 4A, 4B: malignant pleural effusion or EOC with distant metastasis other than peritoneal metastasis

In order to realize a complete tumor staging, all features considered in the FIGO staging system have to be checked.

• Pleural Effusion

  Verheul et al. in their study, observed that malignant ascites and pleural effusion in cancer patients contained high levels of active VEGF-A and hypothesized that blocking VEGF-A expression may benefit patients with recurrent ascites or pleural effusion [omicsonline.org]

  effusion or EOC with distant metastasis other than peritoneal metastasis In order to realize a complete tumor staging, all features considered in the FIGO staging system have to be checked. [symptoma.com]

  T3c N0/1 IV Distant metastasis excluding peritoneal metastasis TX NX M1 IVA Pleural effusion with positive cytology TX NX M1 IVB Metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of abdominal cavity) or parenchymal [bccancer.bc.ca]

  The presence of pleural effusion does not necessarily indicate disease in the chest, and malignancy can be diagnosed only cytologically. [medscape.com]

To date, EOC treatment is mainly based on surgery and chemotherapy: Women diagnosed with stage 1 EOC are generally referred for bilateral salpingo-oophorectomy or total abdominal hysterectomy. Those who wish to preserve fertility may possibly opt for unilateral salpingo-oophorectomy, but this approach requires close postoperative monitoring. Cytoreductive surgery is carried out in case of advanced-stage EOC and may be preceded by neoadjuvant chemotherapy. EOC patients should receive chemotherapy after tumor removal or debulking. Standard regimens comprise combination platinum-based chemotherapy with carboplatin and paclitaxel, carboplatin and gemcitabine, or carboplatin and pegylated liposomal doxorubicin. Monotherapy with carboplatin is associated with reduced toxicity and has been proven effective in multiple trials. Finally, monotherapy with paclitaxel, pegylated liposomal doxorubicin, or topotecan is another treatment option [9].

Cytoreductive surgery plus conventional chemotherapy may cure more than 70% of patients diagnosed with stage 1 or 2 EOC, but less than 20% of those suffering from stage 3 or 4 disease. Unfortunately though, only 25% of all tumors are detected in stages 1 and 2 [4]. Additionally, multimorbid patients are often unfit for surgical interventions, but sole chemotherapy is not curative [9]. Treatment options presented so far may be combined with radiation, immunotherapy and molecular targeted therapy. Genetic analyses should precede the decision for adjuvant chemotherapy with biologics since certain mutations may render the tumor more or less susceptible to certain compounds [10]. Women carrying BRCA1 or BRCA2 mutations, for instance, may benefit from PARP inhibitors. Women who don't carry such mutations should rather receive niraparib [9].

Prognosis largely depends on tumor grade and stage at the time of diagnosis. For EOC in stages 1 to 4, five-year survival rates have been estimated to 85, 65, 30, and 15% respectively. Stage-independent five-year survival rates range between 35 and 45%, which is due to the fact that most women are diagnosed in advanced stages of the disease [3].

The etiology of ovarian cancer remains largely unknown. Slight differences regarding epidemiological parameters have been observed between different ethnicities, but few of them allow to infer possible causes of the disease:

• Women with a family history of breast and female genital cancer may be predisposed to develop EOC, independent of their country of origin and ethnicity. Their predisposition is generally due to germline mutations in genes BRCA1 and BRCA2: BRCA1 mutations are associated with a lifetime risk of 46%-87% for breast cancer and 39%-63% for malignancies of the ovaries; carriers of BRCA2 mutations have a lifetime risk of 38%-84% for breast cancer and 17%-27% for ovarian cancer [11]. Serous adenocarcinoma is particularly common in patients with BRCA1 or BRCA2 mutations [11].
• With regard to ovarian tumors due to hereditary susceptibility, 65–85% of all patients carry BRCA1 or BRCA2 mutations. The remainder of cases is explained by mutations in genes encoding for DNA mismatch repair proteins, in tumor suppressor gene TP53, and other genes implicated in the double-strand break repair system, such as BRIP1, CHEK2, PALB2, and RAD51. Some of these mutations are associated with hereditary cancer susceptibility syndromes, e.g., Li-Fraumeni syndrome and Lynch syndrome [12].
• Excessive gonadotropin secretion, estrogen and progestogen imbalance, and exposure to carcinogens have also been discussed as possible triggers of EOC, but confirmatory data are scarce [2].

The overall incidence of ovarian cancer is approximately 11-12 per 100.000 women in Europe and North America, with 85-90% of all tumors being classified as EOC. The individual risk of EOC increases with age and postmenopausal women account for the majority of patients [2].

Multiple genetic and epigenetic abnormalities have been detected in EOC. Both the activation of proto-oncogenes as well as the inactivation of tumor suppressor genes may contribute to cancer development, but the latter seems to be more common in EOC. TP53 and PTEN are among the best known tumor suppressor genes involved in EOC pathogenesis, but mutations have also been found in genes OPCML and WWOX, among others. The expression of other genes is altered due to promoter hypermethylation or transcription downregulation. High-grade advanced-stage EOC is characterized by a myriad of gene and chromosomal aberrations, and this fact highlights that genetic stability is decreasing over the course of the disease [1]. There are no universal abnormalities to be found in the majority of EOC - their genetics are as heterogeneous as their radiological and histological appearance.

Few recommendations can be given to prevent the onset of EOC, and none can be provided to avoid sporadic disease. However, members of families affected by ovarian cancer due to hereditary cancer susceptibility may benefit from a personalized risk management. They should be tested for mutations predisposing to EOC and other malignancies. Women who test positive for BRCA1 or BRCA2 mutations, or other genetic defects predisposing to ovarian cancer, should be referred for clinical and radiological surveillance. However, no consensus has been reached about the optimum design of surveillance: Tumors may metastasize before reaching a minimum size for sonographic detection and the serum level of cancer antigen 125 has not been proven to be a reliable marker either. A combined approach based on more sensitive imaging techniques, the inclusion of additional serum biomarkers may yield better results [4].

Even in the absence of pathological findings, carriers may undergo prophylactic salpingo-oophorectomy, but infertility and premature menopause argue against such an intervention [11]. Maintenance of the ovaries until the age of natural menopause may at least alleviate the symptoms of premature menopause. In this context, recent studies point out that high-grade ovarian cancers often originate from the Fallopian tubes and that sole salpingectomy may pose a valuable alternative to salpingo-oophorectomy: The risk of life-threatening ovary cancer would be reduced, but women wouldn't have to suffer the complications of estrogen deficiency [11].

There are distinct types of ovarian cancer and they are classified according to the type of cell from which they originate. In this context, ovarian cancer includes epithelial, germ cell, and stromal tumors, among others [2]. Epithelial malignancies are most common and account for about 90% of all cases. They derive from cells on the surface of the ovary. In clinical practice, however, the differentiation of EOC and epithelial tumors arising from the Fallopian tube, foci of endometriosis, or the peritoneum may pose a major challenge [12].

Although EOC patients are far from asymptomatic, they aren't usually diagnosed with ovarian cancer until advanced stages of the disease [2]. EOC-associated symptoms often resemble those of common gastrointestinal and gynecological disorders, and early-stage EOC is difficult to identify by means of sonography. Still, every effort should be made to identify ovarian neoplasms as early as possible: The tumor stage at the time of diagnosis is the most important prognostic factor. Women who are diagnosed with stage 1 or 2 EOC are likely to survive for more than five years, but mortality is high among those diagnosed with advanced-stage disease [3]. Therapy mainly relies on surgery and adjuvant chemotherapy.

Malignant neoplasms of the ovary may originate from distinct types of cells. Tumors that arise from cells on the surface of the ovary are classified as epithelial ovarian cancer. It is the most common type of ovarian cancer. Affected women may suffer from abdominal or pelvic pain, a premature feeling of fullness, bloating, urinary urgency and frequency for prolonged periods of time before the disease is diagnosed. It is important not to ignore these symptoms although they may just be caused by common gastrointestinal or gynecological disorders. Women who are diagnosed in early stages of the disease have a much better prognosis than those presenting with advanced-stage ovarian cancer.

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