Signs of malignancy may be difficult to detect early. They include:
- persistent or progressive ovarian enlargement in a young women - functional cysts are rarely larger than 8 cm in diameter and tend to regress during the subsequent menstrual cycle
- palpable ovaries in a post-menopausal women - expect the ovaries to be atrophic 2 years post-menstruation
- irregular, nodular, partially solid mass, usually bilateral and fixed
- ascites - never in benign lesions except for a fibroma
Features from spread to other organs may include:
- constipation - from bowel obstruction
- hydronephrosis - from ureteric obstruction
- uterine or vaginal bleeding - from erosion
- lower limb oedema - from thrombosis of the inferior vena cava or an iliac vein
- pleural effusion - from distant metastasis
Occasionally, various paraneoplastic syndromes:
- humorally mediated hypercalcaemia - associated with clear cell tumours
- cerebellar degeneration - associated with antibodies to Purkinje's cells
- seborrhoeic dermatitis - Leser-Trelat's sign