Research shows that late stage diagnosis is a major contributor to the UK’s poor survival rates for ovarian cancer. GPs play a crucial role in ruling out ovarian cancer at the first suspicion, to ensure women are diagnosed at the earliest possible stage.
- Risk factors
- Diagnostic tests
- Common problems diagnosing ovarian cancer
- Screening programmes
The two greatest risk factors for ovarian cancer are age and family history. Almost 85 per cent of all diagnosed cases occur in women over the age of 50.
Find out more about risk factors.
A distinct set of symptoms are experienced, even by patients with very early stage disease, according to conclusive evidence found in recent research.
Symptoms are frequent (usually occurring more than 12 times a month or more) and persistent, and include:
- Increased abdominal size/persistent bloating
- Difficulty eating/feeling full
- Pelvic or abdominal pain
- Needing to wee more urgently or more often
Other symptoms can include unexplained weight loss, change in bowel habits, and extreme fatigue.
Critically, it is not just the presence of symptoms that helps to indicate ovarian cancer. Symptoms tend to be more persistent and frequent than similar symptoms caused by other conditions, for example, Irritable Bowel Syndrome.
You can order symptoms leaflets and posters to help raise awareness with your community in your surgery.
The National Institute for Health and Care Excellence (NICE) gives clear guidance on how to manage symptomatic women:
- If physical examination identifies ascites and/or a pelvic or abdominal mass, the woman should be referred urgently.
- Women reporting persistent or frequent symptoms highly indicative of ovarian cancer should be given a serum CA125 test, particularly if they are aged 50 or over.
- If the CA125 is greater than 35 IU/ml then an ultrasound of the abdomen and pelvis should be arranged.
- If the ultrasound suggests ovarian cancer then the woman should be referred to gynae-oncology.
- Advise women with a normal CA125, or a CA125 greater than 35 IU/ml but a normal ultrasound to return for re-assessment if symptoms persist.
The NICE Quality Standard for ovarian cancer states that ‘women with normal CA125 or, raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, are reassessed by their GP within one month.’
The Department of Health states that if CA125 is below 35 IU/ml then organise a review of patient at six weeks. Ensure appropriate safety netting for re-attendance if symptomatic. If there are still concerns regarding the possibility of ovarian cancer arrange an ultrasound, ideally within four weeks.
Scottish SIGN guidance and the Scottish referral guidelines for suspected cancer recommends that women presenting with symptoms of ovarian cancer are referred for a CA125 serum test and urgent pelvic ultrasound scan. If the pelvic ultrasound is abnormal and or the CA125 result is greater than 35 IU/ml women should referred urgently to secondary care for further investigation.
Target Ovarian Cancer’s CA125 and ultrasound factsheets are available for GPs to give women who are undergoing diagnostic tests. The factsheets outline what the test is for, what to expect when having the test and what the results might mean.
Three quarters of women diagnosed with ovarian cancer will have late stage disease at the point of diagnosis. The challenge for the GP is in the detective work required to weed out cases of ovarian cancer from cases of non-malignant disease.
- Misdiagnosis: Misdiagnosis is common, with women presenting with symptoms of ovarian cancer to initially receive a diagnosis of: irritable bowel syndrome (IBS), diverticulitis, acid reflux, urinary tract infection, or changing menopausal status. NICE and SIGN clinical guidelines advise that women over 50 rarely present with IBS for the first time.
- Bloating: A primary-care based study has shown that abdominal distention (increased abdominal size/persistent bloating – not bloating that comes and goes) is a high-risk symptom, warranting rapid investigation. A separate study found that a key challenge in diagnosis is the different language used by women and doctors, with women often using the word ‘bloating’ to cover both abdominal distention as well as fluctuating bloating and discomfort. Since persistent distension is a key indicator of ovarian cancer and fluctuating bloating is not, this can be a challenge for GPs.
- Follow up consultation: Women often fail to return for a follow up consultation even if their symptoms persist. GPs should encourage women to book a follow-up consultation if symptoms persist (especially in cases where ovarian cancer is suspected). Suggesting that patients keep a record of symptom frequency and persistency may help a follow up appointment.
Target Ovarian Cancer’s 10 Top Tips, developed with Macmillan Cancer Support, is aimed to help patients and GPs communicate more effectively with each other about the symptoms of ovarian cancer. Download the version for GPs, or the version for patients, to hand out.
There is currently no national screening programme for ovarian cancer in the UK.
Two clinical trials are underway to assess the impact of screening on ovarian cancer mortality. Both trials are using the Transvaginal Ultrasound (TVU) and CA125 serum assay as diagnostic tests.
- UKCTOCS: The United Kingdom Collaborative Trial of Ovarian Cancer Screening study has recruited 200,000 women between the ages 50-74 from centres across the UK. Results from this study are expected to be published in the next five years.
- UKFOCSS: The United Kingdom Familial Ovarian Cancer Screening Study will assess if regular screening is beneficial for women at high-risk of developing ovarian cancer. The trial recruited 5000 women aged 35 or over. This is expected to report in the next five years.
Find out more about the current status of ovarian cancer screening in our first ‘Ask the Experts’ podcast.