Most patients present to the doctor with disease outside the pelvis. One of the unusual characteristics about ovarian cancer is that it tends to spread out side the pelvis but stay, for a considerable period anyway, within the abdominal cavity (which of course, includes the pelvic organs and the abdominal organs), the surrounding lining wall of which is called the peritoneum.Within this peritoneal cavity, the cancer cells grow as layers of cells across the peritoneal lining and their growth here evokes a secretory response of fluid into the cavity such that very large amounts of fluid accumulate (perhaps five litres or more). All this is relevant to the mode of presentation of patients to the doctor for it is very often with the symptoms of abdominal discomfort and swelling, pelvic pressure symptoms and gastrointestinal or urinary symptoms (e.g. frequency of need to urinate and inability to hold a full bladder). Occasionally, the disease has spread further afield at the time of presentation to the doctor and the complaint may then be breathlessness if the disease is within the chest (e.g. a collection of fluid in the pleural space which surrounds the lungs) or weight loss and absent appetite if the liver has become involved.
