Does Ovarian Cancer Pain Come And Go

All about ovarian cancer

Ovarian cancer (OC) is among the most widespread and aggressive types of malignancies occurring in women. While early detection and timely treatment is linked to increased likelihood of survival and recovery, identification at later disease stages is associated closely with lethal outcome. Therefore, the ability to diagnose and identify ovarian cancer in its early stages is absolutely crucial to  improve chances at curing it to mitigate high rates of associated  morbidity and mortality. This article will aim to  cover major  signs and symptoms that are commonly seen among individuals affected with ovarian cancer. In particular, the association between recurring pain and likelihood of ovarian cancer will be explained.

What is the cause of ovarian cancer?

Occurrence and development of ovarian cancer has been linked to several factors, among which are dramatic changes in hormonal levels, external triggers as well as lifestyle choices. Importantly, inherited genetic predisposition  has been shown to significantly  increase risk of ovarian cancer, such as  gene mutations (BRCA and KRAS genes), excessive levels of oestrogen, androgens and gonadotropins, and increased level of inflammation-causing cells, cytokines.⁶

Family history of ovarian and breast cancer has been found to increase a woman’s risk of ovarian cancer significantly, and genetic alterations were found in 10-15% of all women diagnosed with ovarian cancers.⁵ Mutations of the BRCA1 and BRCA2 (tumour suppressing genes) were seen more frequently, particularly in the elderly. It has been shown that 10-40% of individuals with BRCA-mutations will eventually develop ovarian malignancies.⁶

Hormonal levels are also an important predisposing factor; it has been seen that increased exposure to oestrogen has a direct link to the increased likelihood of ovarian cancer. Clinical evidence indicates that women who have completed more ovulatory cycles through their lifetime were under the higher risk of ovarian cancer.⁶

Increased levels of androgens and gonadotropins were also found to trigger overactivation of ovarian tissue, release of growth hormones, thus favouring growth and development of malignancies, however the underlying mechanism remains unclear. It has been hypothesised that ovulation initiates activation of inflammatory response within the fallopian tubes, which in turn encourages occurrence of cancerous cells. Factors that prevent excessive and cyclic production of oestrogen and prevent ovulation, such as use of contraceptive pills, early onset of menopause, pregnancy and breastfeeding, were therefore found to be protective of ovarian cancer.^1,5,6

In similar fashion, hormonal replacement therapy (HRT) has been found to increase the occurrence of OC significantly.¹

Some ethnic backgrounds are also known to be under higher risk, particularly  non-Hispanic whites, those of Icelandic descent, American Indians and Alaska Natives, Hispanics, non-Hispanic blacks, and Asians.¹¹

Certain external factors such as environment and diet can influence cancer development, particularly in women under the higher risk category. Some studies report association between decreased dietary fibre and consumption of certain animal fats  and prevalence of ovarian cancer, however the evidence is limited. Additionally, deficiency in important minerals and vitamins that support a healthy immune system, were found relevant. It was evident that low levels of  vitamin D can lead to increased risk of developing ovarian cancer.¹ Other external factors that were found relevant include obesity, tobacco use and lack of physical exercise, although the association between these factors and increased occurrence of ovarian tumours has been inconclusive.²

The following table will attempt to summarise the major risk factors for ovarian cancer.

Signs and symptoms

In early days, ovarian cancer (OC) had been referred to as the “silent killer”, not due to the absence of symptoms, but rather because of their vagueness. Therefore, combination of the occurring sign and symptoms must be carefully  assessed upon suspecting ovarian malignancy. Often, early signs of OC can be overlooked or attributed to different pathologies. Severity of symptoms escalate together with the disease progression, becoming apparent at later cancer stages (III/IV).

The following signs and symptoms^5,7are common: 

• Vaginal bleeding or bloody discharge (particularly in postmenopausal women)
• Bloating and digestive issues, such as frequent and urgent need to use the bathroom/constipation
• Lack of appetite or early satiety upon consumption of a small volume of food
• Skin rash
• Abdominal fullness
• Pain or pressure in the pelvic area
• Abdominal pain radiating to the back
• Weight loss

Complications

Women affected by ovarian cancer were found to have various complicationsincluding:¹¹

• Severe fatigue (75%)
• Nausea (71%)
• Constipation (49%)
• Swelling of the ankles and feet (44%)
• Anaemia (34%) 

Without immediate medical help, women have been reported to suffer serious complications like fluid collection in the upper abdominal organs (ascites), bowel and bladder obstruction, accumulation of fluid in the parenchymal tissues of the lung, muscle and skeleton wasting (cachexia) and more.¹¹

What does it feel like when having ovarian cancer pain?

Sources of ovarian cancer are not singular and can be a consequence of various underlying processes. There are 3 major identified causes of pain seen in OC:tumour-related pain, medication-related pain and pain of completely unrelated origin.

According to the American Cancer Society, pain associated with ovarian cancer is either sharp or dull, often reported to be centred around the abdomen or/and pelvis, but it can also occur elsewhere (including limbs).¹⁰

Firstly, the tumour itself can cause a painful sensation as it grows and spreads. Pain can linger around the cancerous tissues as fluid accumulates there, but can also radiate towards the lungs, liver and other areas. Persistent pelvic pain or heaviness is not an uncommon feature accompanying both ovarian cancer and a benign ovarian cyst.

Experiencing pelvic, abdominal or back pain or pain during sex  is an important sign to talk to healthcare professionals about.³

Importantly, there’s no single type of pain associated with ovarian cancer. In fact, a wide spectrum has been reported by patients, ranging from dull and achy to sharp and severe. Usually the pain ranking chart allows us to differentiate between mild and severe pain. Sometimes pain associated with ovarian cancer can be mistaken for painful acid reflux. 

Does ovarian cancer pain come and go?

The answer to this is no.  Symptoms of ovarian cancer are persistent, whereby one may experience a dull ache that does not go away, which is frequent  (usually occurring multiple times a month), and has a novel onset.

Ways to overcome the pain for ovarian cancer

Medications

Ovarian cancer related pain can be managed according to its severity. Usually a combination of medications along with alternative therapies is an effective way to relieve or minimise the pain. [9]

If pain is mild, one can refer to  over-the-counter drugs, for instance nonsteroidal anti-inflammatory drugs (NSAID) like aspirin or ibuprofen (Motrin, Advil). NSAIDs help to reduce inflammation and can relieve symptoms of uncomfort and mild pain. However, more severe pain resolution will require prescription medications. These are some of the medications used:

• Nerve block injections that help down-regulate pain signals to nerves, thus have a numbing effect
• Neuropathic pain treatment, these are medications that can suppress nerve-related pain
• Opioids are very strong analgesics that are only prescribed due to unbearable cancer-related pain. These drugs must be taken with precaution, since they are associated with serious adverse effects, among which is drug dependenceafter chronic use. When drug type is selected and used appropriately it is safe to take them, since these are among the most effective ways to manage cancer-induced pain
• Muscle relaxers are drugs that  treat muscle spasms andtightness

Home remedies

Along with conventional treatment, patients can also practise traditional remedies at home to reach maximal results.

• Herbal medicines were shown to be effective at reducing inflammation and diminishing the pain. For example, the use of Ginger root, Zingiber officinale,  has been found to be beneficial when reducing inflammatory damage, and has been found to have an anticancer effect on ovarian cancer cells⁸
• Acupuncture, this therapy utilises thin-needles to stimulate various points around the body that can diminish the pain
• Aromatherapy, essential oils can have a loosening and relaxing effect on muscles and alleviate pain
• Breathing exercises, often ovarian cancer can be accompanied with severe mental health decline, thus increasing the sensitivity to the pain. Diaphragmatic breathing can help to soothe stress by activating the parasympathetic system, which in turn can help reduce the pain

When to consult a doctor

Although  it can be tricky to suspect OC due to ambiguity of the symptoms, paying close attention to the overall well being and new onset of abnormal symptoms is crucial to the detection of ovarian cancer as soon as possible. Females with a history of gynaecological diseases and breast cancer have to be particularly cautious and need to be monitored regularly. Signs such as unusual vaginal bleeding should be addressed immediately by seeing your doctor. Other signs have to be discussed with healthcare professionals if they fail to resolve after two weeks. Although all related symptoms can be completely unrelated to ovarian cancer, it is important to consult a doctor if OC is suspected.

Summary

In conclusion, ovarian cancer is among the most common oncologies seen in women. Its timely diagnosis remains challenging due to its rather silent presentation and vagueness of signs and symptoms. The causes of ovarian cancer can vary significantly and are defined by predisposing factors such as genetics, ethnicity and external features acquired throughout the lifetime. 

One important sign that may indicate presence of ovarian tumour is persistent non-resolving pain, which does not go away and is spread to various body parts, but most commonly in the abdomen and pelvis. 

Management of pain can be achieved via the use of traditional medicine, such as NSAIDs and opioids. Alternatively, patients use home remedies to suppress cancer-related discomfort and pain.

It is important to recognise and address early symptoms of ovarian cancer in a timely manner, as its early detection strongly increases the chances of complete recovery and survival.