It is so important to be aware of your body, and look out for signs and symptoms. Educate yourself and ask questions. You are your own best healthcare advocate,” says Shannon Miller, a seven-time Olympic medalist, and an ovarian cancer survivor. 
A female body contains two ovaries, which form a part of the female reproductive system responsible for the production of eggs or ova, and their release every month via the process called ovulation. The normal process of cell reproduction in the body is strictly regulated, and kept within a limit. Ovarian cancer is the abnormal multiplication of cells in the ovary thus forming a tumor. If not treated, the cancer spreads to other body parts, which is called a metastatic cancer.  
The exact cause of ovarian cancer is not found yet, but there are some predisposing conditions, which increase the risk of its development. The risk increases with increasing age so it typically occurs in women after menopause or with age over 50 years. Women developing this cancer in young age usually have a positive family history with two or more close relatives like mother or sister having the disease. This is due to the inheritance of the BRCA1 and BRCA2 gene mutations showing an incidence of 1 out of 10 cases. Infertile women or women undergoing infertility treatments also show an increased incidence of development of ovarian cancer. On the other hand, multiple pregnancies, breastfeeding, and the use of oral contraceptive pills tend to decrease the chances of developing ovarian cancer. 
In Pakistan, every year thousands of ovarian cancer cases are diagnosed. Ovarian cancer is the second most common gynecologic cancer, but unfortunately the leading cause of gynecologic cancer related deaths. For a long time, ovarian cancer was named a ‘silent killer’. The reason behind this fatal nature of the disease is its late diagnosis. Early diagnosis of any disease is important for good prognosis and increased survival rate because the disease is most curable at the initial stage. In an early-stage diagnosed ovarian cancer, the 5-year survival rate is approximately 85-90% while in advanced stage diagnosis the rate falls to about 10-30%. But sadly in more than 70% of women, ovarian cancer is diagnosed at an advanced stage thus showing a poor prognosis.  

Signs and Symptoms
The early diagnosis of any disease depends on the early identification of its symptoms. The initial symptoms of ovarian cancer are usually vague and frequently come and go, therefore, making the early diagnosis difficult. The non-specific nature of these presenting symptoms often make women associate them with normal processes like aging, weight gain, menopause or other less serious conditions while in some cases these signs and symptoms are confused with other illnesses like some gastrointestinal disease.  

Since the stage at which the ovarian cancer is diagnosed is strongly related to its survival outcome so it is important to have effective strategies for its early diagnosis. A screening test helps identify a disease or its high probability of incidence in asymptomatic individuals very early in the course of that disease. It is very unfortunate that at present no screening method has been developed that can identify ovarian cancer in women who do not have any symptoms yet or who do not have the BRCA gene mutation. So, the only possibility of early diagnosis of this lethal cancer is the identification of its symptoms and giving serious consideration to them. Early recognition of these symptoms provide women with a chance to fight the disease before its progression.
Bloating
An uncomfortable sense of fullness in the abdomen is called bloating. This feeling is experienced by almost every woman especially around the monthly cycle, which is very normal, but a consistent bloating sensation lasting up to three weeks should raise a suspicion. This is one of the most common early symptom of ovarian cancer. A mass growing in the abdomen eventually causes the belly to swell. So, persistent bloating along with the distention of abdomen is a major red flag that should never be ignored.  

Constipation
Constipation is a very non-specific symptom having varied causes ranging from stress and anxiety to gastrointestinal issues, and in some cases complex diseases like ovarian cancer. For that reason, it is important for women to keep an eye on the changes in their bowel habits, and a newly developed constipation that is not relieved by any intervention should never go unnoticed.  
Persistent Pain
Pain is a very common symptom, which can be attributed to any disease. However, a continuous feeling of pressure or pain in the abdomen, pelvis or lower back, which lasts for weeks is an important signal for some serious problem. Women should focus on the character of this pain and identify the factors associated with it in order to differentiate it from other causes.  
Loss of Appetite
Ovarian cancer patients usually face difficulty in eating, feel full quickly, and are unable to finish even small meals, which is due to the growing ovarian mass in the abdomen that puts pressure on the stomach thus reducing the appetite. Beside this, one of the major symptoms of any cancer is weight loss. Therefore, any woman facing significant weight loss or new incidence of loss of appetite should never neglect these symptoms.  
Urinary Problems
The most common urinary problem experienced by women is pain during urination or urgency, and most of the time women think it to be some urinary tract infection (UTI), and it often is. But bladder symptoms in women are also an indication for a gynecologic or reproductive issue particularly ovarian cancer. So, those having urinary symptoms like pain or pressure in bladder, pain while urinating, urgency or frequent urination, which developed recently and lasted for several days should immediately consult a doctor.
At one time or another, women can face one or more of these problems. These symptoms can occur for many reasons so it is not necessary that they always appear due to ovarian cancer. In most of the cases these symptoms are temporary, and they go away with simple treatments. But the symptoms that do not go away easily and persist may be due to ovarian cancer, and they require consultation with a doctor. As the tumor grows, the symptoms increase in severity and by the time it is diagnosed, the cancer has usually metastasized and involves other organs, hence, making treatment extremely difficult. 
So, any woman experiencing these symptoms on most days of the week, lasting for almost three weeks should immediately visit her doctor for a thorough checkup along with investigations to get an early diagnosis because cancers are best treated when detected early. HH

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