When ‘gastric problems’ hide something more serious

A woman feels bloated. She becomes uncomfortably full after eating only a small amount. Perhaps she has indigestion, constipation, abdominal discomfort or needs to urinate more frequently.

The usual conclusion is familiar: “It must be gastric.”

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Most of the time, such symptoms do have harmless explanations. But when they are new, persistent or progressively worsening, they deserve closer attention. They may occasionally be warning signs of ovarian cancer.

This matters because ovarian cancer can be difficult to recognise early. Its symptoms are often vague and overlap with common gastrointestinal and urinary problems. Globally, an estimated 324,600 women developed ovarian cancer and around 207,000 died from it in 2022, according to the International Agency for Research on Cancer. More than half of both cases and deaths occurred in Asia.

Women should therefore pay attention to persistent abdominal bloating or increasing abdominal size, pelvic or abdominal pain, feeling full unusually quickly, changes in bowel habits, urinary urgency or frequency, unexplained weight loss, reduced appetite or persistent fatigue.

These symptoms do not automatically mean cancer. The important question is whether they are unusual for the individual and whether they continue or repeatedly return.

This message is particularly relevant in Bangladesh, where digestive complaints are frequently self-treated or managed for prolonged periods before specialist assessment. Bangladesh already faces a substantial cancer burden: GLOBOCAN estimated 167,256 new cancer cases and 116,598 cancer deaths in the country in 2022. Improving awareness and reducing delays in diagnosis are therefore important components of cancer control.

Risk also rises with age. A family history of ovarian or breast cancer warrants attention, particularly when several close relatives are affected or cancer occurs at younger ages. Inherited mutations such as BRCA1 and BRCA2 can substantially increase ovarian and breast cancer risk, making genetic counselling appropriate for selected women.

There is another important misconception: ovarian cancer does not currently have a proven routine screening test for average-risk women without symptoms. CA-125 testing and transvaginal ultrasonography can be useful when symptoms or specific risk factors warrant investigation, but an annual CA-125 test alone should not be regarded as effective population screening.

When ovarian cancer is suspected, evaluation may include clinical examination, ultrasound, CA-125 and further investigations. Treatment can involve surgery, chemotherapy and, in selected patients, targeted or maintenance therapies. WHO emphasises that cancers identified earlier generally have better treatment prospects, lower morbidity and lower costs of care.

The message is not to create fear around every episode of indigestion. It is to avoid normalising persistent symptoms.

If “gastric trouble” keeps coming back, listen to what your body may be telling you. Awareness should create vigilance, not fear—and timely consultation can make all the difference.

The writer is the President of Medical Oncology Society of Bangladesh and Chief Consultant of Shanti Cancer Foundation.