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.