Nine months — that’s how long Shradha Gupta, 51, waited for an ovarian cancer diagnosis.

“I had a terrible pain in the pelvic region, felt bloated all the time, but the gynecologist kept asking me to wait a few months, as my period had stopped as well, to confirm if it was because of menopause,” says Gupta. “If my doctors and I had been more aware of the symptoms, that something as simple as constantly being bloated could be a tell-tale sign of ovarian cancer, it could’ve been caught sooner.”

Ovarian cancer has the unfortunate reputation of being known as a ‘silent killer.’ Its symptoms are so subtle, they are often waved away as menopause, since both are most common among the same group: women over 50.

Both are characterized by bloating, pain in the pelvic or abdominal region, difficulty eating or feeling full quickly, and a frequent need to urinate. Occasionally there can be other symptoms of ovarian cancer, such as changes in bowel habits, extreme fatigue or unexplained weight loss or gain — again all menopause symptoms. Sometimes, Irritable Bowel Syndrome (IBS) is diagnosed.

By the time ovarian cancer is considered as a possible cause, it usually has already spread to nearby organs, making it more difficult to treat.
According to the Indian Journal of Cancer, ovarian cancer — the third leading cancer among women — has the worst prognosis, with a 5-year survival rate of 45%, “primarily due to the late stage of diagnosis of the disease.”

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Gupta, who has undergone a hysterectomy and ovariectomy, is currently undergoing chemotherapy, and is on her way to recovery, leads a women’s cancer support group called We Will Win. Misdiagnosis is one of the main reasons why three out of five women in her Mumbai-based group have ended up with late-stage ovarian cancers.

“It’s not unusual for a woman newly diagnosed with ovarian cancer to have been seen by a bowel or bladder specialist for her symptoms or for the symptoms to be passed off as menopause at least five to six times before doctors confirm it as ovarian cancer,” says Gupta.

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“Irregularities or the presence of these symptoms do not give away ovarian cancer directly. The first diagnosis is always menopause,” says oncologist Dr Kedar Mugwe. “Therefore, often, the early signs are either ignored, attributed to other conditions, and misinterpreted by general practitioners resulting in delays in women being referred to gynecologists.”

Ovarian cancer, unlike other cancers, lacks viable diagnostic tests. Unlike cervical cancer, which can be detected by a Pap smear, or breast cancer, which can be confirmed by a mammography before a lump is even big enough to be felt, there’s no specific screening available for ovarian cancer.

The only tests available to doctors to detect the presence of ovarian cancer have their own shortcomings. Women can undergo a complete pelvic ultrasound or a Transvaginal Ultrasound (TVUS), but neither are highly reliable in detecting ovarian cancer. They may reveal a mass or tumor in the ovary, they can’t actually tell if it is malignant or benign. A TVUS, which is conducted by inserting an ultrasound wand into the vagina and probing, carries the added disadvantage of being invasive.

Doctors can also order a CA-125 blood test, which measures the amount of a protein (CA-125) in the blood; many women with ovarian cancer have high levels of this protein. However, there are two problems with this test: first, its results can be misleading — high levels of CA-125 can also be caused by conditions like endometriosis and pelvic inflammatory disease — and second, not all women who have ovarian cancer display have high levels of CA-125.

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This leaves both doctors and women with one, rather unremarkable tool for the earlier detection and treatment of ovarian cancer: awareness.

“If you think you have any of these symptoms that have persisted long enough, please don’t hesitate in asking for tests or more time from the doctor to research and look into your case,” Dr Mugwe says. “Insist on getting tested for ovarian cancer that usually means an ultrasound or an exploratory surgery to examine the ovaries directly.”

“My advice to both doctors and patients is to not show a low threshold for considering ovarian cancer as a possibility,” he adds.