Throughout the years, ovarian cancer has been referred to as the “silent killer” for women as early stages symptoms are subtle, non-specific, and often resemble those of other common conditions, such as Irritable Bowel Syndrome (IBS), digestive issues or urinary tract infections (UTIs).
As discussed in one of our previous articles, ignoring these symptoms leads to a late diagnosis and subsequent higher mortality rate. Women diagnosed at an early, non-metastatic stage have over a 70% chance of survival, which drops to 15% when the disease is diagnosed at a late stage1. As research progresses and awareness on the topic grows, more people are beginning to recognise the distinct warning signs of ovarian cancer and that symptoms must not be overlooked by either clinicians or patients.
The main subtypes of ovarian cancers
First, it’s important to outline the different ways ovarian cancer may present in patients. There are three main subtypes: germ cell tumours (GCTs), sex cord-stromal tumours (SCSTs), and epithelial ovarian cancers (EOCs). Each differs in origin, presentation, prognosis, treatment, and genetic background2.
Epithelial ovarian cancers comprise approximately 90% of all ovarian malignancies and represent the most clinically aggressive subtypes. It arises from the surface epithelium of the ovary and typically affects postmenopausal women. Its primary risk factors include age, obesity, hormone replacement therapy, family history of gynaecological cancers, and genetic predispositions such as mutations on the BRCA1/2 genes. Another risk factor is the prolonged lifetime exposure to ovulatory cycles and subsequently the hormonal fluctuations. Consequently, onset of menstruation before the age of 12(early menarche) , late menopause, and never having been pregnant (nulliparity) are all associated with an increased risk of developing ovarian cancer. This subtype often presents with nonspecific symptoms such as bloating, pelvic or abdominal pain, quickly feeling full after eating small portions, or even urinary urgency. Upon diagnosis, treatment typically involves a combination of surgery with chemotherapy. Targeted therapies, such as poly-ADP ribose polymerase (PARP) inhibitors and antiangiogenic agents, have shown promise, especially in patients with specific genetic mutations3.
Germ cell ovarian tumours are mostly benign, yet in rare cases can be cancerous, originating from primordial germ cells. They account for 2-3% of all ovarian cancers and occur predominantly in adolescents and young women up to their early 30s. The risk factors include genetic conditions affecting sex chromosomes, birth defects involving the genitals or urinary tract and family history. They often present with acute abdominal swelling or pain, rapidly enlarging pelvic masses, vaginal bleeding, irregular periods and elevated levels of tumour markers, such as alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG)4,5. Upon diagnosis, surgical removal of tumours along with adjuvant chemotherapy is often proposed. GCTs have an excellent prognosis due to their marked chemosensitivity, particularly to platinum-based combination regimens, and are rarely hereditary6.
Sex cord–stromal tumours are a diverse group of cancers, arising from the ovarian stroma and hormone-producing cells. They represent about 5-7% of all ovarian cancers and can present at any age7. Risk factors include hormonal imbalances or exposure, certain genetic conditions, and family history of ovarian or breast cancer. Such tumours often secrete oestrogen or androgens, leading to endocrine manifestations such as abnormal uterine bleeding, especially postmenopausal bleeding, abdominal pain or swelling and signs of hormonal imbalance such as voice deepening or increased body hair. Upon diagnosis, surgery is the primary treatment which is often curative if diagnosed when the tumour is still confined to the ovary. In certain cases, additional treatments may include chemotherapy or hormonal therapy8.
Not so innocent: The symptoms every woman must know
All these subtypes have one thing in common; if diagnosed early they have favourable outcomes. There are five key symptoms a woman should watch for that are common in all types of ovarian cancer9:
- persistent bloating
- abdominal or pelvic pain
- fatigue that doesn’t improve with rest
- changes in bowel habits
- frequent urination
These symptoms may seem minor or common and do not always mean cancer. Most of the time, it’s indeed another condition. However, when these symptoms are persistent or worsening and conservative relief approaches like painkillers, change in diet do not help, it is imperative that women advocate for a thorough clinical assessment clearly and assertively with their healthcare providers. If ovarian cancer is suspected, individuals should insist on a specialist referral, intravaginal ultrasound, and blood test to account for the genetic factors and the proteins (cancer markers) that are elevated in cases of a malignancy. Early diagnosis is vital for improving outcomes in ovarian malignancy.
A united approach on ovarian cancer prevention
Beyond patients, the healthcare system must reassess the way it approaches women with increased risk factors. Currently, significant geographic and demographic disparities exist in accessibility of genetic testing and counselling for women from under-represented groups. Consequently, many high-risk individuals remain unidentified. Additionally, there is a widespread lack of awareness among both patients and healthcare providers regarding ovarian cancer, its symptoms, who actually is at an increased risk, and the importance of genetic counselling and risk-reducing strategies. A recent UK study showed that 40% of women mistakenly believe that ovarian cancer can be diagnosed with cervical screening while almost half (46%) of GPs still incorrectly believe symptoms of ovarian cancer only present in advanced stages. These findings underscore the urgent need for national awareness campaigns, particularly in regions where misinformation is prevalent and late-stage diagnoses are more common10.
Furthermore, in cases of family history and due to aggressiveness of the disease, preventative surgeries (e.g. risk-reducing bilateral salpingo-oophorectomy) may be considered by the medical team and the patient. Recent research indicates that adopting a risk-based triage approach, incorporating both age and CA125 levels – a commonly used biomarker to detect and monitor certain types of cancer – can enhance the detection of ovarian cancer in women over 50, potentially leading to earlier diagnosis and improved outcomes11. However, due to the age factor, this strategy may not be as effective for younger women11. In addition, in younger ages, such preventative surgeries can be deferred as they eliminate the possibility of having children and/or lead to early menopause. In September 2025, the University College London Hospitals NHS Foundation Trust (UCLH), in collaboration with the NHS North Central London Cancer Alliance (NCLCA) and GENinCode Plc, became the first hospital Trust in the UK to provide a new ovarian cancer surveillance testing service. The study monitors high-risk women with BRCA1 or BRCA2 gene alterations using the ROCA Test, which calculates individual ovarian cancer risk from CA125 blood levels, age, and menopausal status. Regular testing every four months aims to detect cancer earlier, reducing late-stage diagnoses, demonstrating feasibility and cost-effectiveness within the NHS12. Such programs, once proven successful, should be adopted nationally to improve the ovarian cancer care landscape, rather than continue to rely on individual initiatives from specific trusts only.
At the same time, private health insurers should play a proactive role by including preventive screenings for women. Although most provide coverage for cancer treatment costs, they do not provide any coverage for preventative exams for women, such as transvaginal ultrasounds, mammograms or cervical screening. Doing so would complement NHS efforts by having individuals engage with needed systems early, improving health outcomes.
In a nutshell, ovarian cancer is not silent – it “whispers,” and we need to listen carefully. Improved awareness, earlier diagnosis, and better diagnostic tools can dramatically change survival outcomes. We must stop calling ovarian cancer silent and instead start amplifying its signs. By recognising symptoms early and acting on them, women can face this disease with the best chance they can have. Everyone – patients, clinicians, policymakers, and insurers – has a part to play in confronting ovarian cancer head-on through vigilance, education, and preventive action.
References
- Ovarian cancer – spotting the “silent killer” – Cancer Research UK – Cancer News. (n.d.). Retrieved October 20, 2025, from https://news.cancerresearchuk.org/2008/11/21/ovarian-cancer-spotting-the-silent-killer/
- Types of ovarian cancer | Cancer Research UK. (n.d.). Retrieved October 20, 2025, from https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/types
- Arora, T., Mullangi, S., Vadakekut, E. S., & Lekkala, M. R. (2024). Epithelial Ovarian Cancer. https://www.ncbi.nlm.nih.gov/books/NBK567760/
- Germ cell ovarian tumours | Cancer Research UK. (n.d.). Retrieved October 20, 2025, from https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/types/germ-cell
- Germ cell ovarian cancer | Macmillan Cancer Support. (n.d.). Retrieved October 20, 2025, from https://www.macmillan.org.uk/cancer-information-and-support/ovarian-cancer/germ-cell-ovarian-cancer
- Zhang, X., Yang, J., Xiang, Y., Wu, M., Cao, D., Wang, J., & Yang, J. (2024). Predicting outcomes in malignant ovarian germ cell tumors using the modified International Germ Cell Cancer Collaborative Group classification system. International Journal of Gynecological Cancer, 34(11), 1745–1752. https://doi.org/10.1136/IJGC-2024-005489
- Sex cord-stromal cancer – The Eve Appeal. (n.d.). Retrieved October 20, 2025, from https://eveappeal.org.uk/sex-cord-stromal-cancer/
- Educational Materials | Foundation For Women’s Cancer. (n.d.). Retrieved October 20, 2025, from https://foundationforwomenscancer.org/resources/educational-materials/
- Five silent symptoms of ovarian cancer – UAB News. (n.d.). Retrieved October 20, 2025, from https://www.uab.edu/news/health-medicine/five-silent-symptoms-of-ovarian-cancer
- Key facts and figures | Target Ovarian Cancer. (n.d.). Retrieved October 20, 2025, from https://targetovariancancer.org.uk/about-us/media-centre/key-facts-and-figures
- Wu, R., Arendse, K. D., Hamdani, T., Walter, F. M., Crosbie, E. J., Mihaylova, B., & Funston, G. (2025). Cost-effectiveness of CA125- and age-informed risk-based triage for ovarian cancer detection in primary care. British Journal of Cancer, 1–9. https://doi.org/10.1038/S41416-025-03166-3;SUBJMETA
- UCLH launches new ovarian cancer surveillance service for women at high risk : University College London Hospitals NHS Foundation Trust. (n.d.). Retrieved October 20, 2025, from https://www.uclh.nhs.uk/news/uclh-launches-new-ovarian-cancer-surveillance-service-women-high-risk