Traditionally, ovarian cancer has been considered a “silent killer” that does not produce symptoms until far advanced. Some patients with ovarian cancers confined to the ovary are asymptomatic, but the majority will have nonspecific symptoms that do not necessarily suggest an origin in the ovary. In one survey of 1,725 women with ovarian cancer, 95% recalled symptoms prior to diagnosis, including 89% with Stage I/II disease and 97% with Stage III/IV disease. Some 70% had abdominal or gastrointestinal symptoms, 58% pain, 34% urinary symptoms, and 26% pelvic discomfort. At least some of these symptoms could have reflected pressure on the pelvic viscera from the enlarging ovary.

Metastatic ovarian cancer is rarely asymptomatic. In addition to the gastrointestinal and urinary symptoms noted in early stage disease, formation of ascites can produce an increase in abdominal girth. Pleural effusion may lead to dyspnea as the first complaint. Acute symptoms, such as those of adnexal rupture or torsion, are uncommon. Vaginal bleeding is also an uncommon symptom in postmenopausal women, although premenopausal patients may present with irregular or heavy menses.

Detection of an adnexal mass by pelvic examination can permit the early diagnosis of ovarian cancer. Since malignancy is rare and the majority of palpable adnexal masses are benign, an enlarged ovary discovered on pelvic examination is not likely to be an ovarian malignancy. In premenopausal women, ovarian cancer is uncommon and represents less than 7% of all adnexal masses. Even in postmenopausal women, 70% to 80% of adnexal tumors are benign. In some patients who complain primarily of abdominal symptoms, a pelvic examination frequently is omitted and the tumor missed. Signs of advanced disease include abdominal distension and a fluid wave consistent with ascites. These signs are nonspecific and can be associated with many conditions arising in the abdominal cavity, especially malignancies of other primary sites or carcinomatosis from metastatic tumors of the gastrointestinal tract and breast.