Cathy Brockhoff thought she had very bad indigestion when she woke up early one morning with a stomachache.

She took a few antacid tablets, but the ache progressed from major discomfort to so much pain that it hurt to lie down. Brockhoff woke up her husband and told him she needed to go to the hospital. Something was very wrong.

She suspected a gallbladder problem or pancreatitis, but after multiple tests and imaging, a sonogram detected a mass on her ovary. At just 47, she was diagnosed with ovarian cancer — a disease that usually strikes women in their 60s.

“This literally came out of the blue. … It was very crazy,” Brockhoff, a teacher’s assistant who lives in Coram, New York, tells TODAY.com.

“I still process it when someone says to me, ‘ovarian cancer.’ Like it still makes your stomach drop, even though it’s three years later. Because I’m still like, wow, that’s me. That’s still surreal.”

Most ovarian cancers develop after menopause, the American Cancer Society notes.

But it can strike before then, says Dr. Antoinette Sakaris, a gynecologic oncologist at Northwell South Shore University Hospital in New York. She treated Brockhoff and calls her diagnosis “definitely on the younger side.”

“That’s why her story is actually quite important to bring to the public,” Sakaris tells TODAY.com.

“So that women hopefully can be more in tune with looking for subtle symptoms of ovarian cancer.”

Brockhoff’s sudden and severe stomachache in 2023 wasn’t a typical warning sign, but it was actually “fortunate” because it triggered the ER visit that led to imaging that found the tumor, the doctor adds.

Ovarian cancer symptoms are often much more vague, allowing the cancer to grow and spread undetected — a big reason why it’s the most lethal gynecologic cancer, researchers note.

Most Cases Are Random

Ovarian cancer is rare — about 1% of women in the general population will be diagnosed during their lifetime, according to the National Cancer Institute.

Brockhoff says ovarian cancer was “completely off the radar” for her. No one in her family has had it, and genetic tests after her diagnosis found she didn’t have genetic mutations that can significantly raise the risk of the disease.

Like 75% of patients, Brockhoff’s case was “a random event,” Sakaris says.

Risk factors include older age, a family history of the disease and having a harmful genetic mutation. Up to 58% of women who inherit a BRCA1 mutation and up to 29% of women who have a BRCA2 mutation will develop ovarian cancer, according to the National Cancer Institute.

Never being pregnant can also raise the risk because “unrelenting ovulation” is a risk factor, Sakaris notes. Pregnancy and birth control pills are protective against ovarian cancer because they reduce the number of ovulations a woman has in her lifetime.

Still, most women who are diagnosed are not at high risk, the Centers for Disease Control and Prevention notes.

There’s no screening — like a mammogram for breast cancer — or blood test available for the general population, so it’s key for women to know and report the symptoms to their doctor.

Ovarian Cancer Symptoms

When it comes to warning signs, think of the acronym BEAT, which stands for bloating, early satiety, abdominal pain and toilet changes, Sakaris advises:

Bloating

Feeling like your pants are too tight and noticing the abdomen getting larger is one of the main symptoms a doctor monitors in her own body.

It happens when excess fluid, called ascites, builds up in the belly, causing it to swell, the American Cancer Society notes.

Since bloating is very common, it’s the persistence of it that matters, Sakaris says. Watch for bloating that doesn’t go away with a bowel movement and continues for weeks.

“Imagine looking like you’re four or five months pregnant, but you’re not,” she notes.

“We tell women, ‘If for two weeks or more, you’re having a persistent daily bloating or fullness in the abdomen that’s not going away, bring it to your physician’s attention.’”

Early Satiety

This means feeling full quickly after eating and may happen because a tumor or fluid buildup in the belly limits how much food the stomach can hold.

“I often tell patients, ‘If you had your most favorite beverage and food in front of you from your favorite restaurant or cafe, you are getting ready to eat it, and you can’t eat beyond a few bites and you feel very full with or without nausea, that’s worrisome,’” she says.

“If there’s a mass … that can slow down the transit of our gut, and so everything feels like it’s backing up on you.”

Abdominal Pain

Brockhoff says this was the only symptom she experienced.

Her sudden stomachache is less common and was likely caused when the ovarian cancer tumor grew, then bled into itself and pushed on nearby organs, Sakaris says.

But most women describe a gradual, progressive onset of abdominal pain over a month or two, she adds.

Toilet Changes

This includes bowel and bladder changes such as frequent urination, narrow stools and feeling like the bowels don’t fully empty.

It happens because the bladder can’t hold as much urine as it normally would if there’s a tumor taking up space in the pelvis. Similarly, a mass could press on the rectum or the colon and cause constipation.

If you always drink a lot of water and are used to going to the bathroom frequently, notice any changes from baseline, Sakaris advises.

In a ‘Good Place’ After Treatment

After being diagnosed with Stage 3 ovarian cancer, Brockhoff underwent surgery to remove the tumor, her uterus and her ovaries, plus a portion of her colon that was near the mass as a precaution.

She then had six rounds of chemotherapy, followed by targeted therapy drugs. October marks three years since scans showed no evidence of disease. Brockhoff feels lucky she had a warning sign she couldn’t ignore and says she’s in a “good place” thanks to her family’s support.

She urges women to pay attention to their body, and not ignore symptoms.

“Working and raising kids, we don’t always take the time out to realize, ‘I’ve had this stomach ache for four days,’” she says.

“I feel like we constantly make excuses or push things (off) because we’re always going forward in another direction. We have to stop doing that.”

This story first appeared on TODAY.com. More from TODAY:

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