It is more difficult to catch the mouse in the house than the gorilla in the villa.
A mouse moves quietly at night, leaving only the faintest signs of its presence. By the time you notice the damage, it has already moved through every room. Ovarian cancer behaves in a similar way. It develops quietly, exhibiting vague symptoms that are easily mistaken for indigestion, menopause, or the stresses of everyday life. By the time it becomes obvious, the disease has often advanced beyond the ovaries. The challenge is that its early warning signs are so common and nonspecific that they are frequently overlooked by both the women affected and health care providers.
Unlike breast or cervical cancer, the proverbial gorilla in the villa (as they are easier to detect because of more obvious manifestations), ovarian cancer does not have an effective population-wide screening test.
Mammography has transformed breast cancer detection, and pap smears have dramatically reduced deaths due to cervical cancer. Unfortunately, no comparable test exists for ovarian cancer. Blood tests such as CA-125 and ultrasound imaging may be useful in selected women, but they are not accurate enough to screen the general population.
As a result, nearly 70 per cent of ovarian cancers are diagnosed only after the disease has spread beyond the ovaries. At this stage, treatment becomes far more complex, often involving extensive surgery (occasionally more than one) and multiple cycles of chemotherapy. Although remarkable advances in targeted therapies and maintenance treatments have improved survival, early diagnosis remains our greatest opportunity to improve outcomes.
What are the challenges?
One of the greatest challenges is that the symptoms are subtle and nonspecific. Persistent bloating, feeling full after eating small amounts, pelvic or abdominal pain, increased urinary frequency, constipation, or unexplained fatigue are common complaints that most women experience at some point. The key to understanding the disease is not that these symptoms occur—it is that they persist. Symptoms that occur almost daily for more than two to three weeks deserve medical attention.
Women should also be aware of their personal risk. A family history of ovarian or breast cancer, especially at a young age, may indicate an inherited mutation such as BRCA1 or BRCA2. These women require genetic counselling, regular specialist follow-up, and in some cases preventive surgery. Identifying high-risk women is currently one of the most effective forms of 'screening' we have.
So, should every woman undergo annual ultrasound scans or CA-125 blood tests? Current international guidelines say no. Large clinical trials have shown that routine screening in women at average risk does not significantly reduce deaths from ovarian cancer and may expose women to unnecessary surgery and anxiety. This often surprises people, but it highlights an important truth: not every test that detects abnormalities saves lives.
What we need instead is greater awareness and smarter risk assessment. Women should know the warning signs and should not ignore persistent symptoms. Primary care physicians should maintain a high index of suspicion, particularly in women over 50 years of age or those with a significant family history. Genetic testing should become more accessible, and families with inherited cancer syndromes should be identified early.
The mouse in the house is difficult to catch because it hides so well. September is Gyneacological awareness month. And one of the trickiest cancers to catch early is ovarian cancer.
The message is simple: persistent symptoms should never be ignored simply because they seem ordinary. Paying attention to the body's quiet signals—and developing better tools to detect disease earlier—offers our best chance of improving outcomes for women with ovarian cancer.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
