Recognizing the symptoms of ovarian cancer and uterine cancer

Doctor explains patient's test results to woman.

Ovarian cancer has been called the silent killer, but if you listen closely, your body may be trying to tell you something.

"Ovarian cancer has symptoms that are subtle and vague, and often ignored or chalked up to something else," says David O. Holtz, MD, gynecologic oncologist at Main Line Health. "By the time symptoms become more serious, the cancer is often at an advanced stage and more difficult to treat."

Unlike ovarian cancer, endometrial cancer (also known as uterine cancer) will often have recognizable symptoms early on. Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Sometimes called uterine cancer, it's the most common type of cancer that affects the female reproductive organs. With roughly 60,000 new cases of uterine cancer diagnosed every year, it's also one of the only cancers increasing in the U.S.

"Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system," says Dr. Holtz. "But if you catch both of these cancers early, they're very treatable. The five-year survival rate for cancer that hasn't spread is more than 90% for ovarian and endometrial cancer."

Symptoms of ovarian and endometrial cancer

Dr. Holtz encourages women to be mindful of changes to their digestion, appetite or weight and talk to a health care provider if these symptoms persist for two weeks or more.

Symptoms common to both ovarian and endometrial cancers include:

  • Bleeding after menopause
  • Bleeding between periods
  • Periods that are heavier or longer than usual
  • Unusual vaginal discharge
  • Pelvic pain or pressure
  • Pain during sex

Additional symptoms of ovarian cancer include:

  • Feeling full too quickly or difficulty eating
  • Bloating
  • Abdominal or back pain
  • More frequent or urgent need to urinate and/or constipation

"At this time, there are no good screening tools for ovarian or endometrial cancer, so it's important to be aware of risk factors and pay attention to your body," says Dr. Holtz. "These symptoms are often a result of something other than cancer, but it's always best to follow up with your primary care provider or gynecologist if you've been in pain or uncomfortable for some time. Regardless of the cause, they can help you find treatment and relief."

Endometrial cancer risk factors and prevention

The average age of women diagnosed with endometrial cancer is 60, although taking steps to reduce your risk can begin much earlier.

"While we don't know exactly what causes endometrial cancer, we do know it's affected by a woman's hormone balance, which is affected by weight and other factors. Women who are overweight or obese are up to three times more likely to get endometrial cancer compared with women at a healthy weight. Women with hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome) also have a very high risk of endometrial cancer," Dr. Holtz says.

Factors that increase your risk for endometrial cancer include:

  • Age 50 or older
  • Obesity
  • Metabolic syndrome
  • Estrogen treatment without progesterone for hormone replacement during menopause
  • Early menstruation, late menopause or never having been pregnant
  • Polycystic ovary syndrome
  • Infertility
  • Type 2 diabetes
  • Tamoxifen for prevention or treatment of breast cancer
  • Family history of uterine, colon or ovarian cancer
  • Breast or ovarian cancer
  • Endometrial hyperplasia

"The best ways to prevent endometrial cancer are to maintain a healthy weight, stay physically active, discuss the pros and cons of hormone therapy with your doctor and get treated for endometrial problems," says Dr. Holtz. "You should also discuss the possible benefits and risks of taking birth control pills, which may reduce your risk for endometrial cancer. And if you have HNPCC or Lynch syndrome, your doctor may recommend having your uterus, ovaries and fallopian tubes removed to prevent endometrial cancer."

Ovarian cancer risk factors and prevention

While ovarian cancer is also most common in postmenopausal women, there are steps you can take to reduce your risk.

Risk factors for ovarian cancer include:

  • Age 55 or older
  • Overweight or obesity
  • Hormone therapy after menopause
  • Family history of ovarian, breast or colorectal cancer
  • Genetic mutation called BRCA1 or BRCA2, or one associated with Lynch syndrome
  • Breast, uterine or colorectal cancer
  • Endometriosis
  • Having children later or never having a full-term pregnancy
  • Fertility treatment
  • Eastern European or Ashkenazi Jewish background
  • Smoking

"There's no known way to prevent ovarian cancer, but there are some factors associated with a reduced risk," says Dr. Holtz. "Using birth control pills can reduce your risk by half when taken for more than five years, and they don't have to be consecutive years. Pregnancy and breastfeeding have also been shown to reduce risk. Having a hysterectomy or surgery to remove your ovaries and fallopian tubes when childbearing is completed can significantly reduce risk as well."

It's most important to talk to your doctor about ways to reduce your risk. While these things may help reduce your chance of getting ovarian cancer, they're not recommended for everybody, and risks and benefits are associated with each.

Genetics and Risk Assessment Program

Ovarian and endometrial cancer have a strong genetic correlation. Knowing whether you have inherited a cancer-related gene may help you and your doctors determine a plan for early detection and prevention. Certified genetic counselors in the Genetics and Risk Assessment Program gather information about your personal medical history and family cancer history. If inherited risk is suspected, you may consider genetic testing.

Next steps:

Make an appointment with David O. Holtz, MD 
Learn more about our Genetics and Risk Assessment Program
Gynecological cancer symptoms and how to recognize them