(CBS) think detecting ovarian cancer symptoms is easy? think again. Even doctors have a hard time making the call. in part, that's because many of the symptoms, like weight gain and abdomen pain, could be a host of things, or nothing at all.

It's no small problem. Each year around 20,000 American women get ovarian cancer in the United States and yet many are not fully aware of the warning signs.

The symptoms, according to Medline are:

- Heavy feeling in pelvis- Pain in lower abdomen- Bleeding from the vagina (especially after menopause)- Weight gain or loss- Abnormal periods- Unexplained back pain that gets worse- Gas, nausea, vomiting, or loss of appetite

Sounds like a lot of things right? and sometimes there are no symptoms at all, which makes things tough on doctors. more than 25 percent of women with apparent  signs of early stage ovarian cancer are not receiving biopsies to test for it, according to new research from the University of California Davis Cancer Center.That's a big deal, because the longer you wait, the more deadly the disease becomes.

To make matters worse, there is no simple screening test for the disease. your doctor can perform several tests to help narrow it down including a rectovaginal pelvic exam, a transvaginal ultrasound, and a CA-125 blood test.

The disease overwhelming strikes older women – 90 percent are over 40 and most of those are over 60, according to the Centers for Disease Control (CDC).

There are several things that can lower your chance of getting the disease and some risk factors too. Here's the short list, according to the CDC.

LOWER YOUR RISK

- having used birth control pills for more than five years.- having had a tubal ligation (getting your tubes tied), both ovaries removed, or hysterectomy (an operation in which the uterus, and sometimes the cervix, is removed).- having given birth.

RISK FACTORS

- being middle-aged or older.- having close family members(such as your mother, sister, aunt, or grandmother) on either your mother's or your father's side who have had ovarian cancer.- having had breast, uterine, or colorectal cancer.- having an Eastern European (Ashkenazi) Jewish background.- having never given birth or having had trouble getting pregnant.- having endometriosis (a condition where tissue from the lining of the uterus grows elsewhere in the body).

For more information check out Medline, the Mayo Clinic and the CDC.

“You are leaning toward ovarian cancer?! but I had my ovaries removed in a complete hysterectomy 23 years ago!!”

I am a retired school principal with a doctorate in Educational Leadership. I love people and enjoy helping others. I have always been a very active person and very healthy until getting ovarian cancer.

I am now a survivor of early stage ovarian cancer for almost two years. I want to help others become more aware of ovarian cancer, especially the symptoms and the lack of screening tests. Breast cancer has mammograms; other gynecologic cancers can be screened with a pap smear. but there is nothing yet for screening ovarian cancer.

The symptoms we now know often mimic so many others, but if they persist for more than a few weeks, see your gynecologist for a pelvic exam, trans-vaginal ultrasound and a CA 125 blood test.

Unfortunately, I explained my symptoms away and convinced myself it wasn’t anything to worry about. perhaps, I can help others recognize the silent symptoms so they will discuss them with their gynecologists.

One of the symptoms of ovarian cancer that I experienced was bloating. Well, for many of us women, bloating is something we are very familiar with and tend to dismiss with monthly periods, eating too much popcorn or peanuts, or just retaining water.

Another symptom is unexplained weight loss or weight gain. I was watching my weight, eating right, and exercising regularly, but began gaining weight. I called my doctor to see if my new medicine was causing the weight gain. although he said no, I didn’t follow up on the cause.

Abdominal pain is also a silent symptom. Years ago, I mentioned abdominal pain to my gynecologist. After numerous tests that showed nothing, she said it was probably the “phantom ovary”—similar to someone having a leg amputated but still feeling pain from it. Eventually, the pain went away. When it returned, I referred to it as the “phantom ovary” and gave it no further thought.

A persistent lack of energy or fatigue— I was feeling unbelievably tired the weekend before my diagnosis. but my husband and I are always on the go—I thought I just needed to slow down a bit.

Back pain is also a symptom that I had. my back often hurts and I have had two back surgeries. When I began having back pain, again I dismissed it as normal back pain due to so much lifting with 3 grandchildren.

Did you know that • Ovarian cancer occurs in 1 out of 71 women? • Ovarian cancer is very treatable when it is detected early, but 81% of cases are not diagnosed until the cancer has spread or advanced? • 3 out of 4 women will be diagnosed with ovarian cancer in the later stages where the survival rate is only 25%? • 50% of women diagnosed with ovarian cancer will die within 5 years; among African American women that number increases to 54%. • Ovarian cancer has been labeled the “silent killer” because the signs and symptoms are linked with many other types of illnesses and because there is not a test, a vaccine or an accurate screening tool? • Chances of ovarian cancer increase with menopause, a family history of ovarian, breast or colon cancer, or not bearing a child.

Many gynecologists do not ask their patients about ovarian cancer symptoms, and many patients are unaware of the symptoms to ask questions. as students in the medical field who are hearing this, perhaps you will ask your patients specific questions. Finding ovarian cancer in its earliest stages makes a big difference in survival! With early detection, the survival rate of five years or longer is greater than 90%.

I began having severe abdominal pains right after I went to bed. Five or six hours later, my husband took me to the emergency room where we both thought the doctor would give me an antibiotic and send me home. that was not the case. He found a mass that needed to be removed and had called in a surgeon. the surgeon said there were three possibilities of what he would find in surgery: • Colon cancer • Diverticulitis • Ovarian cancer When he said he was leaning toward ovarian cancer, I was shocked. “You are leaning toward ovarian cancer?! but I had my ovaries removed in a complete hysterectomy 23 years ago!!” the doctor shrugged his shoulders and said that’s what he thought it was. to me, this was the kiss of death! I had always heard that no one survived ovarian cancer. thank goodness this isn’t so, and more good news is on the horizon as more advanced research continues.

After I had been diagnosed with ovarian cancer, I wondered why I had not taken the CA 125 test during my annual gynecological exams. I thought this was a screening test for ovarian cancer. I did not know there was no test for ovarian cancer. I also thought a Pap smear would give some indications!

The surgeon and oncologist removed an ovarian tumor mass about the size of a golf ball. it was localized—the entire tumor was removed and it did not appear that any cancer spread beyond the tumor. a more extensive pathological report gave more details, and the course of action was determined. the oncologist said it was at a stage between 1 and 2. I had chemotherapy of carbo-platinum and taxotere every 21 days for six months.

The oncologist also said that even without the ovaries, it was still ovarian cancer and was treated and managed as ovarian cancer. There are not many cases like mine. a general gynecologist might see 1 or 2 in a lifetime; my cancer hospital sees a handful each year.

Had I not gone to the emergency room for what I thought was a diverticulitis flare-up, I wonder how long it would have been before I would be diagnosed with ovarian cancer? That’s why it’s a blessing—mine was caught in the early stages! until we have a screening test for ovarian cancer, we need to spread the awareness symptoms to all women and all doctors and nurses, which will help with early detection for more women, and that will save more lives!