Ovarian cancer can be difficult to spot — but not necessarily because the signs aren't there.

"People sometimes call it a silent killer. I wouldn't say it's silent, I would say it's subtle, because things are happening," says Dr. Anne B. Alaniz, a gynecologic oncologist with Houston Methodist.

It's subtle because the symptoms are ones that women can experience off and on during their lives. They're also common symptoms for other conditions, too. And unlike breast cancer, cervical cancer and colorectal cancer, ovarian cancer doesn't have a preventive screening test available. That makes pinpointing these changes sooner rather than later especially important.

Dr. Alaniz says that knowing ovarian cancer symptoms, your family health history — especially for gynecological conditions such as ovarian cancer — and any personal risk factors can help women understand their risk and get help when they notice persistent signs.

Ovarian cancer symptoms to watch out for

1. Bloating

Bloating is when the stomach feels full or bigger than usual. When you're bloated, your stomach can make noises, you can feel discomfort or pain, and you might pass gas more than usual.

Feeling bloated after a big meal or after eating certain foods is common. And women might be used to feeling bloated before or during their periods. But bloating should come and go fairly quickly — if it doesn't, you should talk with your doctor.

"It's one thing to be bloated for a day or two," Dr. Alaniz says. "It's another thing altogether to have two or more straight weeks of bloating. The persistence of bloating is really what most people have to pay attention to and realize that maybe it's not diet."

2. Feeling full faster than usual

Feeling satiated, or full, after eating less food might seem like a good trait since maintaining a healthy weight can sometimes be challenging.

"Another symptom that we see is getting fuller faster than usual, or early satiety," Dr. Alaniz says. "This is where patients realize when they eat a very small amount of food but start to feel fuller faster than usual. Sometimes it gets to a point where you eat maybe 50% of your meal, and you feel like you ate five plates of food. They may even get to a place where all they can tolerate is one meal a day."

3. Abdominal pressure or pelvic pressure

Women may feel discomfort in their abdomen and pelvis that they struggle to make sense of or attribute to GI issues, especially when the pressure exists in the abdomen.

"It's not really intense or very painful," Dr. Alaniz says. "So often women say, 'I just feel a heaviness in this area.' They can't really attribute it to anything, but the sensation just feels heavy and off."

4. Frequent urination

Needing to urinate often isn't always a cause for concern. Anything from drinking more fluids, medication you're taking, or bladder muscle changes can cause you to go to the bathroom more often. But urinating frequently can also be caused by infections such as urinary tract infections (UTIs) and conditions such as diabetes, an overactive bladder and ovarian cancer.

"They're going to the bathroom and urinating very frequently, and they feel like their bladder is full, but when they go, they just go a little bit," Dr. Alaniz says. "So they get a really big urge to go, and then it doesn't match the output, or they have trouble passing it."

5. Getting up at night to urinate (nocturia)

Frequency isn't the only urinary symptom. Nocturia is defined as waking up to urinate during the night, sometimes several times. Nocturia can be a bothersome, albeit common symptom — one in three adults over age 30 make at least two trips to the bathroom each night, according to the National Center for Biotechnology Information. It can be caused by anything from how much fluid a person drinks to sleep disorders and aging.

Dr. Alaniz says that women should take note if they're usually a sound sleeper and never had to get up at night to go to the bathroom before — and now they're getting up every night. It's easy to attribute it to getting older, but sharing this symptom with your doctor is important, especially if it's paired with any of the above symptoms.

Ovarian cancer shares symptoms with other conditions

Because these five symptoms are so common, it's easy for women to discount them and attribute them to less serious conditions.

Dr. Alaniz says that women with gastroenterological (GI) conditions, such as irritable bowel syndrome (IBS) or celiac disease, can have many of the hallmark signs of ovarian cancer: feeling gassy, feeling distended and having abdominal pelvic pressure from the bloating, and getting fuller faster.

It's when women seek care from a gastroenterologist for their symptoms and undergo tests — such as an EGD (esophagogastroduodenoscopy, an endoscopy of the esophagus, stomach and small intestine) and colonoscopy — that then come back as completely normal that should raise concern. It's at this point that Dr. Alaniz says that women will look for other answers to explain away their symptoms.

"They start looking at other things to palliate that — 'maybe I'm having too much Starbucks,' 'maybe I need to cut down on dairy products' or 'maybe I need to cut out beans,'" Dr. Alaniz says.

For urinary symptoms, Dr. Alaniz says that women may attribute their urgency and nocturia to UTIs. These infections are surprisingly common in women. Over half of women will experience a UTI in their lifetime, with the most common type being bladder infection, according to the National Institute of Diabetes and Digestive and Kidney Diseases. And one in four women will have recurrent UTIs, meaning they will have at least two in six months or three in a year.

"So sometimes they may just call their doctor and say, 'I'm going to the bathroom all the time, and when I go, I'm just going a little bit. I don't feel like my bladder is really empty.' And the provider will go, "Oh, we'll send you an antibiotic,'" Dr. Alaniz says. "And sometimes you hear these women say, 'I've been treated for six urinary tract infections in the last however many months.' And those urinary tract infections never really were UTIs, it was always related to their cancer.'"

Dr. Alaniz says women should not give up if they have explored what's causing their symptoms, and there has been no clear answer.

If you've had unsatisfactory results self-treating multiple different symptoms — symptoms you may not have known come with ovarian cancer — it's time to see your OB-GYN or primary-care doctor, says Dr. Alaniz.

"Ask them if they're concerned whether this could be ovarian cancer," says Dr. Alaniz. "Because at that point, it's worth having imaging studies to further evaluate your symptoms versus continuing to keep taking things over the counter and hope that those persistent symptoms are going to go away."

What women can do before ovarian symptoms appear

1. Know your risk

While the exact cause of ovarian cancer is unknown, there are certain things that can make you more at risk for developing the condition. Ovarian cancer risk factors include:

• Being overweight
• Being 60 or older
• Experiencing endometriosis
• Having children later in life or never carrying a pregnancy
• Starting your period at a young age
• Having a family history of ovarian cancer or have a gene mutation such as mutation BRCA1, BRCA2 or Lynch syndrome

Dr. Alaniz emphasizes that knowing your family history can give you a lot of information that can help you and your doctor potentially stay ahead of a cancer diagnosis.

"I think it's good to know your family history," Dr. Alaniz says. "Some of the older generations didn't share a lot of information, especially about female-related health issues, since they didn't feel like those things should be talked about. But knowing this history is important because for some patients it's the first time they realize there isn't a reason for their symptoms. They start to ask around and start seeing patterns of multiple family members developing different kinds of cancer."

Dr. Alaniz says that based on your family history, your doctor may recommend you undergo genetic testing if you meet all the criteria.

"And then, if you are found to have a mutation that puts you at risk of ovarian cancer, there are options for what we do for those patients, such as risk-reduction surgery," she says.

2. Know your body

It's important to know what's normal for your body and what's not, so you can notice subtle changes. Paying attention to your body means everything from your breasts, periods, weight, bathroom habits, sleep, energy levels and more.

"I want women to be attentive to their bodies," Dr. Alaniz says. "Women, in general, can be caretakers or nurturers. I can't tell you how many times women come to my office, and they'll say things like, 'Well, I started feeling this a year ago, but I had to take care of my daughter,' 'I had to take care of my grandchildren' and 'I had to do all these things, and then now that I'm done, I'm coming in to address the problems that I've been having.' I think that women need to be able to take the time to take care of themselves."

3. Get your yearly well-woman exam and physical

A large part of caring for yourself includes getting care before you have issues. That includes working with a primary-care provider for your annual checkups, immunizations and screenings, and a well-woman exam with an OB-GYN. Even for those with the busiest schedules, Dr. Alaniz says there is always time for you to prioritize your health and well-being.

"You can take an hour to see your doctor and be attentive to your body," Dr. Alaniz says. "A well-woman exam is your time once a year to see your OB-GYN and talk to them about how you're feeling, and they will talk to you about your symptoms, and you can work together to address those things."