Ovarian cancer and bloating: Why cancer can be mistakenly dismissed as IBS

Joanne Messeri grew up with what her mom called a “nervous stomach.” Joanne, who beat ovarian cancer once and is currently battling it a second time, had experienced symptoms of irritable bowel syndrome (IBS) since she was young. So when her stomach started acting up more severely, at first she thought nothing of it.

Joanne, who lives in Ohio, says, “I’ve had a nervous stomach my whole life. So, constipation, bloating, and diarrhea were normal for me.” But four years ago, after eventually seeking medical help, she was diagnosed with ovarian cancer. After her first diagnosis, the treatment was effective and she was cancer-free, but she later had a recurrence.

Like many others, Joanne’s experiences with IBS led her to dismiss her ovarian cancer symptoms initially. Dr. Amanda Kallen, associate professor of obstetrics, gynecology, and reproductive endocrinology at Yale School of Medicine, explains why this is a common issue. “Unfortunately, some of the signs of ovarian cancer, such as abdominal bloating or fullness, change in appetite, indigestion, nausea, and changes in bowel movements, are similar to the signs of IBS, which can lead to a delay in diagnosis,” she says. 

Of course, the majority of people who notice these symptoms won’t have ovarian cancer. It’s always important to pay attention to your body’s signals, but it’s also important not to stress by worrying too much. As we’ll delve into later in this article, there are various causes of these kinds of digestive symptoms — and most have absolutely nothing to do with cancer.

Dismissing ovarian cancer as IBS bloat

IBS is a disorder affecting the digestive system. We don’t know what causes it, although some experts have previously linked it to food passing through the gut too quickly or too slowly, having oversensitive nerves in the gut, or a family history of the disorder. Symptoms of IBS include: 

• Cramping
• Abdominal pain
• Bloating
• Constipation
• Diarrhea
• Gas

Frustratingly, ovarian cancer symptoms can overlap with IBS symptoms, meaning they’re sometimes mistakenly dismissed as less serious than they actually are.

When Joanne experienced her first symptoms of ovarian cancer — bloating and feeling full — she assumed the signs were part of her IBS. “I just didn’t pay any attention to it,” she says. Joanne also recalls needing to pee more often, as well as noticing “a feeling of fullness I never had before.” But she didn’t think much about it — or the pain she had been experiencing in her left hip bone. “I just figured I was exercising a lot,” she says. “I figured I strained a muscle during crunches.”

“Determining whether symptoms are from ovarian cancer or from another cause can be complicated,” says Dr. Cynthia DeTata, a clinical assistant professor of obstetrics and gynecology. And sometimes, that can lead to a delayed diagnosis. 

“Unfortunately, ovarian cancer is often caught in later stages when symptoms become more obvious. But if we can catch ovarian cancer in the early stage, it could be treated early and potentially be curable,” she adds.

What are the symptoms of ovarian cancer?

Ovarian cancer will affect one in every 78 women throughout their lifetime, and it usually emerges in older women, with around half of cases affecting those aged 63 years or older. Cancer in the ovaries can be more difficult to detect than other types of cancer because it typically presents as a “constellation” of symptoms, rather than just one prominent sign, like a lump in the breast tissue.

Some of the more common symptoms of ovarian cancer include:

• Bloating
• Pelvic or abdominal pain
• Feeling full quickly or difficulty eating
• Peeing often or always feeling like you need to go

Of course, as Dr. DeTata points out, many of these signs can be “subtle” and are “similar in nature to other common health problems” that aren’t always serious. So how can you tell the difference between ovarian cancer symptoms and something else? It’s all about how persistent the symptoms are, as well as how severe they are and how different from your “normal” you feel. Generally, the advice is that if you have any of the above symptoms more than 12 times a month, it’s worth getting it checked out. But always listen to your body; if you feel concerned about a persistent symptom, even if it’s not happening 12 times a month, book an appointment with your health care provider. This is especially true if you’re at a higher risk of ovarian cancer, for example if you have the BRCA 1 gene or a family history of the condition.

Also keep an eye out for some of the other less common symptoms of ovarian cancer. These can include:

• Heartburn
• Constipation
• Extreme tiredness
• Upset stomach
• Back pain
• Nausea
• Pain during sex
• Shortness of breath
• Changes to your menstrual cycle (e.g., heavy or irregular bleeding)
• Weight loss and a swollen belly

Why does ovarian cancer lead to bloating?

Bloating is one of the more confusing ovarian cancer signs because it can be such an everyday symptom. But why does it happen in people with ovarian cancer? When you have a cancerous tumor on your ovaries, it causes a buildup of fluid (known as ascites), which can cause the belly to swell. This can be mistaken for bloating, but where IBS bloating or bloating from noncancerous causes generally comes and goes, this kind of swelling doesn’t.

Ovarian cancer bloating can also be triggered by a blockage of the lymphatic system (a network of thin tubes and lymph nodes that’s a key part of the immune system). If a cancerous tumor on the ovaries is blocking the system, then lymph (the fluid containing white blood cells that fight off bacteria and viruses) won’t drain well, so it builds up around the stomach.

In some more serious ovarian cancer cases, severe bloating may be an indication that the cancer has spread. If it has spread to the membrane that lines the inner abdominal wall, it can cause irritation and stimulate the membrane to produce excess fluid, which gathers and causes bloating.

You may also be wondering what ovarian cancer bloating feels like. Often, it’s described as an uncomfortable feeling of tightness and may also cause some pain or the feeling of needing to pass gas. 

When to seek help for ovarian cancer symptoms

As we’ve seen, bloating is one of the more common signs of ovarian cancer, but that doesn’t mean you should immediately panic if you notice the symptom. There are several reasons you may be experiencing bloating that have nothing to do with cancer at all. They include:

• IBS
• A high-sodium diet
• Weight gain
• Side effects of some medications
• Constipation and gas 
• Many women and people who menstruate also experience bloating before or during their period. 

However, it’s always important to advocate for your own health and to speak up when something feels off. So if you notice that your bloating — or any of the other symptoms listed above — isn’t going away, you should consult a health care professional.

Joanne’s diagnosis resulted from a planned trip to Vietnam and Cambodia with her son. In the run-up to her trip, she remembers thinking, “I need to get this pain checked out, so it doesn’t [cause issues while I’m away].” 

If you’re experiencing any of the symptoms of ovarian cancer, speak with your health care provider and clearly describe your symptoms and your concerns. If your doctor is dismissive, ask for tests that can produce more answers, especially if you feel you are at a higher risk of developing ovarian cancer. Switch to a different doctor if you feel you’re not being heard.

How is ovarian cancer detected and diagnosed?

Joanne’s doctors performed an ultrasound due to the pain on her left side. Through that, they found she had “two grapefruit-sized tumors” on her ovaries. From the time Joanne’s symptoms first presented to the time of her diagnosis was approximately eight months — but the sooner you can catch it, the better.

If your health care provider thinks something may be wrong or finds something unusual during a pelvic exam, they may recommend screening tests. These can include imaging tests, an ultrasound, CT scans, X-rays, MRI scans, and biopsies. Once a diagnosis is given, a treatment plan will be discussed. Treatments for ovarian cancer can include surgery, chemotherapy, hormone therapy, and radiation.

For Joanne, her treatment began with a “debulking” surgery, which she says is “the standard protocol — just removing everything in the area: lymph nodes, uterus, fallopian tubes … the whole nine yards.” For Joanne, protecting her fertility wasn’t an issue because she’d passed reproductive age. But for anyone facing this kind of surgery who’s planning to have children in the future, possible measures to preserve fertility will be discussed before the procedure. 

After her surgery, Joanne went on to have six rounds of chemotherapy. Despite the heavy load of treatment, she says she wasn’t scared of her diagnosis. “My doctor said, ‘We’ve got this early; you’re going to be fine.’ I felt strong and ready to tackle it.”

Joanne even ended up going on her Southeast Asia trip between treatments. “My doctor was very confident that we were going to get this handled. And her confidence really helped me,” she says.

Ovarian cancer bloating: The takeaway

Bloating might be one of the key symptoms of ovarian cancer, but it’s also a common indication of less serious health conditions, which is why it’s sometimes dismissed. Remember: Book an appointment with your health care provider if bloating or any of the other ovarian cancer symptoms become persistent. In most cases, it won’t mean you have cancer — but for those that do, the earlier it’s caught, the easier it is to treat.

And Joanne’s advice to anyone who’s diagnosed with ovarian cancer? “Don’t look on the internet! No matter the prognosis, you can still maintain a healthy, happy life. You can choose how you react to the situation. It’s all in your attitude, surrounding yourself with people you care about, and finding joy in the little things.”