Bloating, acidity, abdominal discomfort, and feeling full too quickly, many women mistake these symptoms for digestive issues. Doctors warn that when such complaints linger, they may point to something far more serious. Ovarian cancer, often called the “silent killer,” continues to have one of the highest mortality rates among cancers affecting women, largely because it is diagnosed late and remains poorly understood.
Unlike breast or cervical cancer, it’s not easy to read ovarian cancer’s symptoms as they are subtle. The ovaries being deep inside the abdomen, early tumours often grow quietly without causing obvious symptoms. By the time women seek medical help, the disease has already spread. The late diagnosis comes at a heavy cost.
According to figures published jointly by the Global Cancer Observatory, Cancer Today and the World Health Organization in 2022, ovarian cancer accounted for 47,333 cases in India, making it among the most common cancers affecting women in the country.
A report published in the Indian Journal of Gynecologic Oncology found ovarian cancer ranked among the top 10 cancers across several population-based cancer registries in India, with rates showing a steady rise over the decades, particularly in cities such as Bengaluru and Bhopal. Doctors say these numbers may reflect not just rising disease burden but also an uncomfortable truth: that its awareness remains worryingly low.
“Ovarian cancer is usually aggressive and often presents in advanced stages, when the disease has already spread to many organs. Despite treatment, these cancers may recur and slowly develop resistance, which contributes to progression and fatality,” explains Dr Abhilasha Narayan, consultant in gynaecologic oncology, robotic and laparoscopic surgery at HCG Cancer Hospital, Bengaluru.
Why is ovarian cancer called a silent killer?
Unlike cervical cancer, which can show up through screening, or breast cancer, where a lump may alert a woman, ovarian cancer throws up symptoms that are vague and easy to ignore.
“Ovarian cancers, especially the aggressive high-grade types, grow rapidly and tend to produce vague symptoms, often only in advanced stages,” says Dr Narayan. This means women may spend months treating themselves for gastric issues or menstrual discomfort without suspecting cancer. “Symptoms such as bloating, indigestion, acidity, abdominal discomfort or urinary complaints are frequently dismissed as food-related or digestive problems,” she adds.
Dr Snehal Kohale, consultant fertility specialist and gynaecologist at Tieten Medicity, Thane, sees this delay often. “What worries me clinically is that ovarian cancer symptoms are usually vague and ignored for months. Persistent bloating, abdominal fullness, early satiety, unexplained weight changes, pelvic pain or increase in abdominal size lasting more than two to three weeks should not be overlooked, especially if the symptoms are new, progressive and occurring almost daily,” she says.
This tendency to normalise symptoms is one of the reasons behind high mortality. The National Cancer Registry data has revealed that many patients reached hospitals only after the disease had become locally advanced or spread further.
Dr Kanika Batra Modi, Director, Gynecologic Oncologist at Max Cancer Care, Saket, points out a crucial gap which is delayed access to specialised care. “Women living in small towns and rural areas often have symptoms that are treated normally at the primary level instead of being investigated thoroughly. There are also financial limitations and the lack of regular gynecological check-ups that contribute to delayed diagnosis,”
No reliable screening tool
It’s important to take into account that ovarian cancer has no dependable mass screening test. “There is no good routine screening test for ovarian cancer. Ovarian cancer symptoms are non-specific such as bloating, abdominal pain, indigestion or urinary changes. They are usually not identified as symptoms of cancer,” emphasises Dr Rashmi Rekha Bora, head and senior consultant in gynaecologic oncology at Dharamshila Narayana Superspeciality Hospital, Delhi.
Doctors caution against the belief that ultrasounds or tumour marker blood tests can detect the disease. “CA-125 and ultrasound are not enough to screen for ovarian cancer. CA-125 may be normal in early cancer and may also rise in non-cancerous conditions such as infection, menstruation or endometriosis. Ultrasounds can miss subtle or early changes,” says Dr Bora.
Used without clinical judgement, these tests may create either false reassurance or unnecessary anxiety. Dr Narayan agrees, “These methods have not reduced ovarian cancer mortality in studies and are not recommended for mass screening.”
The genetics connection
Family history remains one of the strongest risk factors. Women with close relatives affected by breast or ovarian cancer may carry inherited mutations, particularly in the BRCA1 and BRCA2 genes.
“Ovarian cancer risk is greatly influenced by family history and genetics. Women with a mother, sister or daughter diagnosed with ovarian or breast cancer have a significantly higher risk,” says Dr Bora. She believes India still has limited awareness around genetic counselling.
“Women with strong family histories should definitely consider genetic counselling. Testing can identify individuals at risk early and help guide monitoring or preventive strategies. But testing should always be done under medical supervision,” adds Dr Bora.
Health practitioners are of the view that lifestyle alone is not responsible for ovarian cancer; certain modern habits may influence overall cancer risk and resilience. “Obesity, inactivity, stress, delayed pregnancies and hormone imbalance can increase overall cancer vulnerability and make disease harder to manage,” remarks Dr Bora.
To discover ovarian cancer diagnosis at an advanced stage is emotionally devastating. According to Dr Modi, “The word cancer itself leads to that devastating feeling, but as 70 to 80% of women with ovarian cancer are diagnosed at the last stage, it becomes a shock to them. Most patients come expecting a minor issue as the symptoms are considered normal, and suddenly they are faced with the reality of cancer, surgery, and uncertainty about the future. It is studied as well that almost 46% of women with Ovarian cancer have markedly higher anxiety and depression than the general female population, and nearly half of the women receiving systemic therapy screened positive for moderate or severe distress,”
Hope floats
Treatment has improved significantly over the last decade, giving hope to thousands of patients.
“Survival outcomes have improved because of better surgery, advanced chemotherapy, targeted therapies like PARP inhibitors and immunotherapy in selected cases. The biggest difference is that many patients are now living longer with better quality of life, especially when diagnosed early and managed through a multidisciplinary approach,” expresses Dr Kohale.
Ovarian cancer may be called a silent killer, but doctors insist it is not completely silent. The body often sends signals, which we fail to listen to.
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