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10 Warning Signs Of Prostate Cancer Men Shouldn’t Ignore

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Cancer is a disease that can affect almost every major organ in the body – from our skin to our liver. However, prostate cancer affects more men than any other cancer type apart from skin cancer. Based on data between 2010 and 2012, the NIH estimates that an astonishing 14 percent of the male population will be diagnosed with some form of prostate cancer in their lifetime. An estimated 220,800 cases were reported in the USA in 2015, with deaths at 27,540. By 2012, there were almost 3 million men living with prostate cancer in the US. It’s important not to live in fear, but the statistics should concern you enough to be more vigilant regarding your health and the health of your loved ones. Remember, the biggest fight against cancer starts with prevention. [1]

Getting To Know The Prostate

The prostate is part of the male reproductive system that is found just underneath the bladder. Roughly the size of a walnut, this gland produces fluid that supports the sperm used for sexual reproduction. The prostate grows naturally throughout the lifetime in two major “growth spurts”. The first obviously happens during puberty and the other during a man’s thirties. The weight of the gland grows from about 20 grams during adulthood to double its weight by time a man reaches his 70s. [2] However, the sudden growth of the prostate can put pressure on its surrounding organs and tissues and cause pain and problems with urination and bowel movement. Learn about these warning signs and symptoms of prostate cancer below.

#1: Painful Or Difficult Urination

Dysuria is a term that means painful or difficult urination. With this symptom, you may find it difficult to urinate even if your bladder feels full; or be able to urinate but with mild to severe pain in the pelvic or perineal area (but note that a burning sensation in the urinary tract is usually due to a urinary tract infection). Dysuria is a cause for concern because it can indicate that something may be pressing against your urinary tract (the tract that allows urine to flow out from the bladder) most likely an enlarged prostate, a symptom of prostate cancer. [3]

#2: Frequent Urination

Frequent urination can also be a sign of prostate cancer. When the enlarged prostate or tumor compresses the bladder, it reduces its capacity to hold urine – ergo, more frequent trips to the bathroom to urinate. This can also lead to a feeling that your bladder isn’t fully empty even after repeated urination. [3]

#3: Very Weak Urine Flow

Slow or reduced urine flow usually accompanies the previous symptoms mentioned above. When something is blocking the urinary tract or bladder, the urine flow is greatly reduced, often to a mere dripping or dribbling. This also makes it hard to direct the stream of urine, even with a lot of force being made by the abdominal muscles during urination.

#4: Hematuria

Blood in the urine or hematuria is a cause for worry for anyone – male or female. In the case of prostate cancer, blood in the urine can indicate that the tumor has damaged the urethra or bladder – causing bleeding.

Bear in mind that severe problems with urination are late symptoms of prostate cancer – usually occurring when the prostate gland has already reached a large enough size to disrupt the normal function of the urinary system.

#5: Blood In Semen And Painful Ejaculation

As with hematuria, there should be concern if blood appears in semen. Vascularized tumors are prone to bleeding, which can be the reason why blood-tinged semen is considered a sign of prostate cancer. The tumor itself can be bleeding or damaging surrounding prostate tissue to cause bleeding and pain.

#6: Swelling Of The Legs And Feet

There are two ways wherein prostate cancer can affect the lymph nodes – the first by compressing them, affecting the flow of lymph fluid in and out of the nodes and the second by metastasis to the lymph system. When the ducts that lead to and from the lymph nodes near the pelvic area become blocked, it causes a build-up of fluid in the lower extremities. This can cause mild to severe edema in the ankles and feet, or even the entire leg. However, lower extremity lymphedema usually happens after surgery and therapy but there is still a risk of it occurring prior to the start of treatment, depending the stage of the tumor. [4]

#7: Pain In The Hips, Back, Or Chest

When prostate cancer has reached the last state (stage four), it has usually spread or metastasized to other parts of the body. The most common place where prostate cancer metastasizes is bone. This is why pain in the hips (pelvic bone), back (spine), and chest (ribs) are indicative of widespread bone metastasis in cases of prostate cancer. In a study on prostate cancer in 2000, 90 percent of autopsies done on people who died of prostate cancer revealed bone metastasis. [5]

#8: Urinary And Stool Incontinence

When metastasis has spread to the bones in the spinal column, it can start to affect spinal tissue as well. Because the spinal cord is a part of the nervous system and contributes to the control of the muscles of the bladder and the rectum, metastasis can lead to problems with urinary and stool control, manifesting as incontinence. This can start as feeling the urge to urinate and defecate but never making it to the bathroom on time, eventually leading to full incontinence. [6]

#9: Erectile Dysfunction

While many people believe that erectile dysfunction only occurs after treatment for prostate cancer has started, science begs to differ. In a 2015 study on baseline erectile dysfunction and diagnoses of prostate cancer, erectile dysfunction was present in more than half (53 percent) of the total number of subjects, with severe ED occurring in roughly half of that number (24 percent). This demonstrates that baseline erectile dysfunction is a prevalent warning symptom of prostate cancer. [7]

#10: Weight Loss And Fatigue

Unexplained weight loss and fatigue is common among all types of cancer. When any kind of tumor develops, the body basically “feeds” it which causes it to spread and grow. The nutrients sent to the cancer cells starve the healthy cells, leading to weight loss and easy fatiguability. This is actually one of the earliest signs of cancer, with affected people only noting weakness at the beginning stage of the disease to severe fatigue and weight loss as the staging of the cancer progresses. [8]

Your Number One Tactic: Prostate Cancer Screening

Here’s the truth: most of these signs and symptoms only occur when prostate cancer has already progressed to later stages. More often than not, men with the early stages of prostate cancer are asymptomatic – meaning they don’t feel any different or don’t manifest any signs and symptoms of the disease. This is where screening comes in. You may not know it but you maybe be at risk for prostate cancer.

The three most common methods for prostate cancer screening are:

1) digital rectal exams (DREs)
2) prostate-specific antigen (PSA) detection in the blood and
3) checking for the presence of the protein Engrailed-2 (EN2) in the urine.

The first method allows the manual palpation of an enlarged prostate, raising the alarm for the performance of other screening tests to fully assess the condition. The second is also able to detect an enlarged prostate through PSA levels in the blood, which is useful if the prostate cannot be palpated through a DRE. While the ability of these tests to actually detect prostate cancer is not 100 percent, they are very valuable in detecting abnormalities with the prostate and have positive effects on mortality rates beyond 7 years. [9][10]

The EN2 test is based on relatively new research and reported to be not yet available. A laboratory test currently identifies EN2 in urine, and a simple home test kit is envisioned which will be similar to a home pregnancy test strip. [11]

But remember this: Not all enlarged prostates are cancerous.

An enlarged prostate is not always a cause for concern. In fact, this condition is very common in older men – occurring in about 90 percent of men in their 70s and 80s. Hyperplasia or the enlargement of the prostate naturally occurs as a man ages. When this growth doesn’t stop, it can develop into BPH – which stands for benign prostatic hyperplasia, which is not at all cancerous and is generally regarded as not requiring any form of treatment – unless there is great difficulty in urination. However the urinary symptoms of BPH are similar to prostate cancer, which makes adequate screening even more important. [11]

Note: As with the rest of this website, this article is not medical advice nor a substitute for a consultation with a medical professional. We do not advise self-diagnosis or self treatment. If you believe you have the symptoms mentioned or are concerned about your health, please schedule an appointment with your doctor / healthcare advisor.

References:

[1] National Institutes of Health. SEER Stat Fact Sheets: Prostate Cancer. http://seer.cancer.gov/statfacts/html/prost.html

[2] Department of Health and Human Services (Victoria, Australia). Prostate gland and urinary problems. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/prostate-gland-and-urinary-problems

[3] National Institutes of Health. Prostate Cancer Prevention and Early Detection. http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-symptoms-of-prostate-cancer

[4] Rasmusson, E., et. al. (2013). Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842657/

[5] Bubendorf, L., et. al. (2000). Metastatic patterns of prostate cancer: An autopsy study of 1,589 patients. http://www.sciencedirect.com/science/article/pii/S0046817700800350

[6] Alizadeh, M. & Alizadeh, S. (2014). Survey of Clinical and Pathological Characteristics and Outcomes of Patients With Prostate Cancer. http://www.ccsenet.org/journal/index.php/gjhs/article/view/38296/22260

[7] Ong, W., McLachlan, H. & Millar, J. (2015). Prevalence of Baseline Erectile Dysfunction (ED) in an Australian Cohort of Men with Localized Prostate Cancer. http://www.ncbi.nlm.nih.gov/pubmed/25847707

[8] Langer, C., Hoffman, J. & Ottery, F. (2001). Clinical significance of weight loss in cancer patients: Rationale for the use of anabolic agents in the treatment of cancer-related cachexia. http://www.sciencedirect.com/science/article/pii/S0899900701800010

[9] Mistry, K. & Cable, G. (2003). Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma. http://www.jabfm.org/content/16/2/95.short

[10] National Institutes of Health. Prostate Cancer Screening – for health professionals. http://www.cancer.gov/types/prostate/hp/prostate-screening-pdq

[11] https://en.wikipedia.org/wiki/Prostate

[12] Roehrborn, C. (2005). Benign Prostatic Hyperplasia: An Overview. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477638/

10 Warning Signs of Colon Cancer You Shouldn’t Ignore

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According to research by The American Cancer Society, an estimated 95,000 new cases of colon cancer and 39,000 cases of rectal cancer are predicted to occur in 2016 in the USA. That brings the risk of developing colorectal cancer to 1 in 21 for men and 1 in 23 for women. [1]

The colon, also called the large intestine, is the last part of our digestive system that handles the food we eat before it passes out as stool. The colon plays a vital role in the body’s nutritional process. But, as with every other part in the body, it can become affected by cancer and colon cancer is one of the more common types. Learn all about signs and symptoms of colon cancer below – and see the foot of the article for info on the importance and types of regular screening performed by medical professionals.

#1: Constipation

If anyone can tell you what your normal bowel habits are, it’s yourself. Some people may be comfortable passing stool everyday while others may be okay with passing every other day. Keeping that in mind, you can easily tell when you are constipated. Your bowel movements may be off or it may be difficult to pass stool. These are tell-tale signs that your colon isn’t functioning as it should. A study in 2003 found a link between constipation and an increased risk for colon cancer, especially among African-American women. Medical researcher Burkitt attempts to explain this through his hypothesis that in constipated people, carcinogens in the stool spend a longer time in contact with the mucosa of the colon, increasing the risk for colon cancer. [2][3]

Occasional constipation is a common condition – but if it is ongoing (especially if other symptoms from this list are present), it can signal a more serious condition. Most people with constipation are only affected owing to poor fiber and water intake as well as lack of exercise. When you don’t have enough fiber in your diet from fruits, vegetables, and grains, stool tends to be hard and difficult to pass. Similarly, a lack of activity and exercise inhibits gut motility, which can lead to constipation.

#2: Diarrhea

On the other hand, frequent bowel movements like diarrhea have also been associated with an increased risk for colorectal cancer. The 2010 study by Simons, et. al. disproved Burkitt’s hypothesis by revealing that there was a positive association between frequent bowel movement and an inverse or negative association between constipation and colorectal cancer. They attempt to explain this through a substance called prostaglandin E2 that helps promote gut motility. However, this substance is also believed to promote tumor growth and inhibit cancer cell death. [4]

So what should you believe? These two contrasting studies make it clear – irregular bowel movements – either too frequent or not enough – both increase your risk for developing colon cancer. Again, the best judge of what “normal bowel movement” is, is yourself and if you haven’t been paying attention, you definitely should. If things seem abnormal, just consult your doctor.

#3: Unrelieved Urge To Defecate

Cancer is usually characterized by the rapid growth and spread of cancer cells, manifesting as a mass or a tumor. When a tumor grows in your colon, it can prevent your stool from moving normally through your colon. In people whose tumors have grown large enough to prevent the normal passage of stool, they may constantly feel an urge to defecate even after going to the bathroom. This is usually coupled with the next item on the list.

#4: Passing Small, Hard Stool

When the stool you pass is small and hard, this can indicate, amongst other things, that a tumor developing in the colon has grown large enough to block the lumen of the large intestine. You may be able to pass stool but not all of it. The result of this small, pebble-like, hard stool that leaves you feeling unsatisfied after defecation. As colon cancer advances, the tumor can grow large enough to cause bowel obstruction and accompanying sickness.

#5: Rectal Bleeding

Rectal bleeding can present itself in two ways when it comes to colon cancer. The first can be due to excessive force used when defecating, or “pushing too hard”. This can strain the muscles and mucosa of the rectum, causing a bleed. The second can be caused directly by the growth of a tumor. The tumor itself may be bleeding (because tumors are highly vascularized) or causing damage to surrounding tissues. Studies have been done on patients who reported rectal bleeding and were later diagnosed with colon cancer. [5][6]

#6: Hematochezia (Blood In The Stool)

In medical lingo, blood in the stool is referred to as hematochezia. Interestingly, there is a way to identify which part of the colon the blood is coming from. The normal passage of stool in the colon goes from right to left – from the small intestine, to the large intestine, then to the rectum. When bleeding occurs in the right side of the colon, the blood in the stool tends to be dark red or maroon – whereas bleeding that occurs in the left side of the colon is appears bright red in stool. This is because the longer the blood has been exposed, the darker its color. Very dark colored blood, close to black, is indicative of bleeding in the small intestine or even the stomach. [7][8]

#7: Abdominal Discomfort / Pain

Discomfort / pain in the abdominal area an be an indicator of many things, from indigestion to IBS – but can also include colon cancer. This would usually accompanied by the other symptoms on this list, including problems with bowel movement. If you can’t pass your stool due to a blockage, it can cause severe discomfort and pain as the stool backs up in your colon. It becomes very dangerous if the stool is not evacuated and continues to build up, which can stretch and rupture the colon. Remember, stool is a non-sterile substance and can cause an infection if it leaks out of the colon and into the surrounding tissue.

#8: Inexplicable Weight Loss

Severe weight loss or cachexia very common in people affected by cancer, because cancer cells “steal” the nutrition made for healthy cells. In the case of colon cancer, weight loss has a more direct cause. When stool backs up in the colon, it affects the way the colon absorbs nutrients. The block basically prevents food from travelling the rest of the colon, causing nutritional deficiency in the body. In fact, in a study involving 3000 cancer patients, more than half of the number of patients (54 percent) with colon cancer were affected by cachexia. [9]

#9: Anemia

Bleeding in the colon can be occult, meaning in early stages you won’t immediately notice it. However, the body does! A person who has been chronically bleeding (even in small amounts) will be anemic. If you take a blood test and your CBC (complete blood count) levels are low, you may be bleeding somewhere internally – coupled with abdominal discomfort and irregular bowel movements, this bleeding may be happening in your colon. This test can be requested from your doctor and is typically performed as a routine aspect of an annual medical checkup.[8]

#10: Unusual Fatigue

In addition to the cancer cells taking up much of the body’s energy, fatigue in colon cancer patients can be linked to bleeding. Persistent bleeding in the colon can cause symptoms of blood loss, which manifests as fatigue, weakness, dizziness, cold sweats, and eventually shock. [8]

Things to remember:

– Risk factors for colon cancer include age, higher intake of red meat, lack of exercise, obesity, “lifestyle vices” and heredity.

– Not all cases of the above symptoms would mean you have colon cancer. The main thing is to get tested, especially as you get older. Regular medical screening is vital.

At least one of the follow tests should be done by men and women with average risk starting at age 50 (as recommended by the American Cancer Society). [10]

– Every year: guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT)
– Every three years: Stool DNA test
– Every five years: flexible sigmoidoscopy, double-contrast barium enema, CT colonography
– Every ten years: colonoscopy

References:

[1] American Cancer Society. Key statistics for colorectal cancer. http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics

[2] Roberts, M., et. al. (2003). Constipation, laxative use, and colon cancer in a North Carolina population. http://www.ncbi.nlm.nih.gov/pubmed/12738468

[3] Burkitt, D. (1971). Epidemiology of cancer of the colon and rectum. http://aje.oxfordjournals.org/content/172/12/1404.long

[4] Simons, C., et. al. (2010). Bowel Movement and Constipation Frequencies and the Risk of Colorectal Cancer Among Men in the Netherlands Cohort Study on Diet and Cancer. http://aje.oxfordjournals.org/content/172/12/1404.long

[5] Jain, S., et. al. (2014). A rare case of medullary carcinoma of the colon presenting as intussusception in an adult with rectal bleeding. http://www.ncbi.nlm.nih.gov/pubmed/25414804

[6] Thompson, M., et. al. (2011). Is earlier referral and investigation of bowel cancer patients presenting with rectal bleeding associated with better survival? http://www.ncbi.nlm.nih.gov/pubmed/20883523

[7] Andrei, G., et. al. (2015). Hematochezia due to Caecal Angiodysplazia led to Diagnosis of a Transverse Colon Cancer in a Young Female Patient: Case Report and Literature Review. http://www.ncbi.nlm.nih.gov/pubmed/26305206

[8] Yang, X. & Pan, K. (2014). Diagnosis and management of acute complications in patients with colon cancer: bleeding, obstruction, and perforation. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076711/

[9] Fox, K., et. al. (2009). Estimation of Cachexia among Cancer Patients Based on Four Definitions. http://www.hindawi.com/journals/jo/2009/693458/

[10] American Cancer Society. American Cancer Society recommendations for colorectal cancer early detection. http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-acs-recommendations




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10 Warning Signs Of Ovarian Cancer Women Shouldn’t Ignore

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Despite the falling mortality rates for ovarian cancer, it still remains as the fifth most common cancer to affect women and accounts for the highest mortality in cancers that affect the female reproductive system.

Ovarian cancer is regarded as a “silent killer” because symptoms can be subtle and only 20% of cases are discovered early enough for treatment. The American Cancer Society has very scary predictions when it comes to ovarian cancer in 2016 – roughly 21,000 women in the US will become diagnosed while 14,000 women will die from it – that’s two out of every three cases diagnosed.

By 2012, almost 200,000 women in the US were living with ovarian cancer and a familial or personal history of gynecological cancer is a risk factor. The overall risk of becoming affected by ovarian cancer is 1 in 75 while the risk of dying from it is 1 in 100. [1][2]

It pays to be vigilant. Take note of the following warning signs that you may have ovarian cancer.

#1: Irregular Menses

Most women are under the impression that their period should come every month – and more or less it should. However, a woman’s menstrual cycle can occur every 21 to 35 days, which is considered as the “normal” length of a typical menstrual cycle. Be aware if your menstruation doesn’t occur regularly according to your own cycle length. Give or take a few days isn’t bad but when the lapses become weeks to months, you may have a problem with your ovaries. As a women ages, menstrual cycles become more regular and shorter. [3]

#2: Prolonged And Heavy Bleeding

Your menstruation (a.k.a. actual bleeding) should last anywhere between 3 to 7 days. The flow usually starts off weak, then gets heavier, before tapering off. The color adjusts too – from bright to dark red as your bleeding stops. However, prolonged, heavy bleeding from the uterus can signify a problem. The walls of the uterus, called the endometrium, are thickened during the regular ovulatory process and slough off during menstruation if you aren’t pregnant (meaning there is no fertilized egg to embed in the uterine walls). If the walls become too thick, you may experience abnormal, heavy bleeding which can indicate a problem. [3][4]

#3: Bleeding In Between Periods

Persistent bleeding not attributed to the normal ovulatory process is definitely a cause for concern. You will be able to differentiate this from menstrual bleeding because of the color and timing. Bleeding in between periods is usually bright red and doesn’t taper off. You will note that you will still get regular menstruation (between 21 and 35 days) and experience bleeding in between. Like pelvic pain, this kind of bleeding can be due to tissue damage attributed to ovarian cancer.

A popular theory that attempts to explain why ovarian cancer occurs is the “incessant ovulation” theory. When menstrual cycles are very short or if bleeding occurs repeatedly every few days or weeks, the ovary and uterus are consistently “disturbed”. This disruption of the surface cells of the ovary and uterus can damage and mutate its genetic make-up (the underlying cause of any cancer) and can hasten the growth of tumors. [5] Note any other vaginal abnormalities and be sure to report these also to your healthcare professional.

#4: Persistent Abdominal Pain

Menstruation can be a very difficult time for some, especially those affected with menstrual cramps aka. dysmenorrhea. Menstrual cramps typically occur right before and during bleeding – for some women, this pain can be severe while others may not feel anything at all. For people with severe menstrual cramps, it can be difficult to tell if the pain is “normal” or not. But remember this – pain that is out of the norm, persists even after menstrual bleeding has stopped and even after taking pain medication and performing relaxation techniques, is dangerous. It can signify tissue damage, internal bleeding (inside the abdomen or pelvis), and even tumor growth. Many cases of invasive types of ovarian cancer are associated with abdominal pain that persists longer than 2 weeks. [6][7] Be wary also of persistent, achy, dull pain in the lower back. Many women patients are reminded by this of labor pain.

#5: Urinary Frequency And Urgency

Increased frequency in urination and increased urgency can also be attributed to the growth of an ovarian tumor. Cancer is characterized by the abnormal growth and proliferation of cells, usually presenting as a mass of cancer cells called a tumor. The continued growth of an ovarian tumor can start pressing against the bladder, contributing to an increased urge to void or urinate, as well as frequent urination. [7]

#6: Irregular Bowel Movement

In later stages of cancer, metastases to nearby organs is very common. When ovarian cancer cells have invaded the small and large intestines, it can manifest as irregular and difficult bowel movement. Be wary of alternating constipation and diarrhea. Invasive types of ovarian cancer can even present as bleeding in the stool. [7]

#7: Abdominal Bloating

Abdominal pain and irregular bowel movement is often accompanied by abdominal bloating and stiffness, or the persistent feeling of “being full” or “gassy”. This can be due to (1) increased gas or (2) ascites. When ovarian cancer has invaded the surrounding tissues in the abdominal cavity, it changes the permeability of the intestinal walls, causing an influx or gas and fluid in the abdominal space. Increasing abdominal girth is considered one of the most common symptoms of ovarian cancer. [8]

#8: Loss Of Appetite

Ovarian cancer is reported to cause a sudden loss of appetite that is markedly out of character for the person affected. Pressure from the tumor itself can cause poor appetite and notably for the person to feel full very quickly. [8]

Because the symptoms of ovarian cancer often occur simultaneously with each other, difficulty eating and abdominal bloating are two that go hand in hand.

#9: Increased Urinary Frequency And Urgency

Urinary issues, for example sudden urges to urinate and urination that is more frequent than usual can be an indication of many things, ovarian cancer included. In the case of ovarian cancer this can include bouts of complete loss of bladder control that get progressively worse over several weeks.

#10: Sudden, Unexplained Weight Loss

Compared to other forms of cancer, cachexia (cancer-related weight loss) manifests in ovarian cancer more prominently. Poor appetite and abdominal bloating coupled with the nutrition and energy stolen by cancer cells make weight loss rapid and more noticeable. The rapid growth and spread of cancer cells take a lot out of the body, affecting the body’s normal balance of energy and nutrition – leading to severe weight loss.

Survival Due To Early Detection

The earlier ovarian cancer is detected, the higher a woman’s chance of survival. If you take note of these warning signs and immediately seek medical help if you experience one or several of them, your chances of becoming an ovarian cancer survivor are actually very high. The following are the chances of survival upon detection of each stage of ovarian cancer: stage I (93%), stage II (70%), stage III (37%), and stage IV (25%). [9]

Goff’s study in 2007 revealed that the symptoms of pelvic pain, urinary frequency and urgency, abdominal bloating, and difficulty in feeding were positively correlated with ovarian cancer if any one occurred greater than 12 times a month consistently, in less than a year. [8]

Note: As with the rest of this website, this article is not medical advice nor a substitute for a consultation with a medical professional. We do not advise self-diagnosis or self treatment. If you believe you have the symptoms mentioned or are concerned about your health, please schedule an appointment with your doctor / healthcare advisor.

References:

[1] American Cancer Society. What are the key statistics about ovarian cancer? http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-key-statistics

[2] National Cancer Institute. SEER Stat Fact Sheets: Ovary cancer. http://seer.cancer.gov/statfacts/html/ovary.html

[3] Mayo Clinic. Menstrual cycle: What’s normal, what’s not. http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186

[4] Hapangama, D. & Bulmer, J. (2016). Pathophysiology of heavy menstrual bleeding. http://www.ncbi.nlm.nih.gov/pubmed/26695831

[5] Cramer, D. (2012). The Epidemiology of Endometrial and Ovarian Cancer. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259524/

[6] US National Library of Medicine. Painful menstrual periods. https://www.nlm.nih.gov/medlineplus/ency/article/003150.htm

[7] Bankhead, C., Kehoe, S. & Austoker, J. (2005). Symptoms associated with diagnosis of ovarian cancer: a systematic review. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2005.00572.x/full

[8] Goff, B., et. al. (2007). Development of an ovarian cancer symptom index. http://onlinelibrary.wiley.com/doi/10.1002/cncr.22371/full

[9] Holschneider, C. & Berek, J. (2000). Ovarian cancer: Epidemiology, biology, and prognostic factors. http://onlinelibrary.wiley.com/doi/10.1002/1098-2388(200007/08)19:1%3C3::AID-SSU2%3E3.0.CO;2-S/abstract