Why Is Ovarian Cancer Often Mistaken for a Stomach Ailment? Lan Chunyan: A Silent Killer That Can Be Prevented and Treated

“More than 70 percent of ovarian cancer patients are already at an advanced stage when they are diagnosed,” said Lan Chunyan (蓝春燕), deputy director and chief physician of the Department of Gynecologic Oncology at the Sun Yat-sen University Cancer Center (中山大学肿瘤防治中心), in a recent interview with Xinhuanet. She said the insidious onset of ovarian cancer and the lack of effective early screening methods are the main reasons it is called a “silent killer.”

Bloating, poor appetite, increasing abdominal girth… These seemingly ordinary gastrointestinal discomforts may in fact be signals that ovarian cancer is quietly spreading within the abdominal cavity. Lan Chunyan warned that postmenopausal women and those with a relevant family history should be especially alert.

“Seed-scattering” spread in the abdomen means symptoms appear late

Lan Chunyan explained that for what is usually called ovarian cancer, the most common subtype, high-grade serous carcinoma, very likely originates in the epithelium of the fimbriated end of the fallopian tube rather than in the ovary itself. Initially, the lesion is extremely small, difficult to detect on routine examinations such as ultrasound and CT, and the patient feels almost nothing unusual.

“Cancer cells may shed from the fallopian tube and spread to the ovaries, peritoneum and omentum like scattered seeds,” she said. Even at this stage, the body does not necessarily show obvious symptoms right away. Only when the tumor spreads widely, gradually enlarges, or ascites appears do patients begin to feel uncomfortable.

These symptoms are often mistaken for gastrointestinal problems: persistent bloating, feeling full after eating very little, loss of appetite, digestive discomfort, or a gradually increasing abdominal girth.

Lan Chunyan stressed that occasional bloating need not cause panic. What truly warrants vigilance is this: new symptoms that were not present before but have recently recurred, do not resolve, or keep getting worse. Especially for postmenopausal women, or those with a family history of ovarian or breast cancer, prompt medical attention should be sought, and the problem should not be treated as a “stomach ailment” for a long time.

With a family history, first seek genetic counseling; preventive surgery requires individualized assessment

If a first-degree relative such as a mother, sister or daughter has had ovarian cancer, one’s own risk may indeed be elevated. If several family members have also had breast, pancreatic or prostate cancer, or if some developed cancer at a relatively young age, there is reason to be alert to the possibility of an inheritable pathogenic gene in the family.

“Ideally, the family member who has already had cancer should first undergo standard hereditary tumor genetic testing,” Lan Chunyan said. In this way, the pathogenic gene in the family is more likely to be identified, and it is also easier for other relatives to undergo targeted testing.

If the affected relative is found to carry pathogenic variants such as BRCA1 or BRCA2, direct relatives can be tested to see whether they carry the same variant. She explained that carrying a pathogenic variant does not mean cancer is certain, but the risk is clearly higher, and targeted preventive measures can be taken in advance.

For women confirmed to carry pathogenic BRCA variants, prophylactic removal of both fallopian tubes and ovaries after they have completed childbearing is currently the most effective way to reduce the risk of ovarian cancer.

Lan Chunyan noted that according to relevant guidelines from gynecologic oncology societies, carriers of pathogenic BRCA1 variants are generally advised to consider surgery at age 35 to 40, while BRCA2 carriers can postpone this to age 40 to 45.

However, this surgery affects fertility and may bring forward menopause in women who have not yet reached it. She stressed that whether and when to have surgery cannot be decided by age alone; it requires combining the gene type, childbearing plans, the age at onset in the family and overall health, with joint assessment by specialists in genetic counseling, gynecologic oncology and reproductive medicine.

Immunotherapy is not a “miracle drug”; benefits vary from person to person

“When immunotherapy is mentioned, many patients ask: ‘I heard it works very well. Can I use it too?’” Lan Chunyan said. Some also understand it as simply “boosting immunity” and believe that being in good health means it will surely work well, which is a misunderstanding.

At present, immunotherapy commonly used in clinical practice mainly includes PD-1 and PD-L1 inhibitors, as well as bispecific antibodies. Normally, immune cells can recognize and attack tumor cells, but tumors use PD-1 and PD-L1 signaling to “apply the brakes” to immune cells. “The role of immunotherapy is to release this ‘brake,’” she said.

“Different patients’ tumors evade the immune system in different ways,” Lan Chunyan explained. Some tumors already contain many immune cells that are simply suppressed, and releasing the brake may allow them to work again; while some tumors have very few immune cells, and even if the brake is released, there may not be enough immune cells to attack the tumor.

Therefore, with the same immunotherapy, some patients see their tumors shrink markedly and remain controlled long term, while others respond poorly or progress again after an initial response. Doctors take into account the tumor type, stage, prior treatments and physical condition, and sometimes also test indicators such as PD-L1, mismatch repair deficiency proteins or microsatellite instability-high.

In gynecologic tumors, immunotherapy has been used in some patients with cervical cancer, endometrial cancer and ovarian cancer, but the conditions for use differ across cancer types, pathological types and treatment stages.

“Immunotherapy is not a ‘miracle drug’ that everyone can use, and it is not a case of the earlier and more it is used, the better,” Lan Chunyan said. The key is to choose the right regimen at the right time according to the patient’s specific situation.

Side effects differ from chemotherapy; do not tough out “new symptoms”

Many patients think that because immunotherapy does not cause hair loss or vomiting, its side effects should be mild and “will pass if you just tough it out.” Lan Chunyan cautioned that immunotherapy is not free of side effects; they are just different from those of chemotherapy.

“Chemotherapy mainly attacks rapidly growing cells and may cause decreases in blood cell counts, nausea, vomiting and hair loss,” she said. Immunotherapy, by contrast, mobilizes the immune system; if it is overactivated, it may fail to distinguish friend from foe, attacking normal organs and tissues while attacking the tumor, which are known as “immune-related adverse reactions.”

Common manifestations include rash, itchy skin, fatigue, and thyroid dysfunction in some patients. A small number may develop pneumonia, enteritis, hepatitis, myocarditis or nephritis, and the pituitary, adrenal glands and pancreas may also be affected. Although serious adverse reactions are uncommon, if not detected and managed promptly, they can be life-threatening.

“The side effects of immunotherapy do not necessarily occur on the day of infusion; they may appear after treatment has continued for some time, or even after the drug has been stopped,” Lan Chunyan said. Even if the drug has already been stopped, any new discomfort should be reported proactively to the doctor along with the fact that immunotherapy was previously received.

Most immune-related adverse reactions are usually manageable if detected and treated early. Doctors decide, based on severity, whether to pause treatment and give drugs such as steroids. She advised that safety cannot be judged only by whether there is hair loss or vomiting. When new symptoms appear that were not present before, especially if they persist or worsen, patients must tell their doctors promptly and not try to tough it out.