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This page is not intended as patient information. For information on seeing your GP about symptoms of ovarian cancer or diagnosis, please visit this page.

Dr Victoria Barber

Dr Victoria Barber, Northamptonshire GP 

"I work as a practising GP in Northamptonshire and work with Target Ovarian Cancer to help train GPs in how to spot and diagnose ovarian cancer early. I know from my own experience the hurdles we face in diagnosing or ruling out ovarian cancer."

GPs play a crucial role in ruling out ovarian cancer at the first suspicion, and ensuring women are diagnosed at the earliest possible stage. National guidelines set out how GPs should assess and refer women with symptoms that could be caused by ovarian cancer.

On this page you will find infomation covering:

Symptoms

Guidance issued by NICE and SIGN recognise the following symptoms most commonly associated with ovarian cancer. 

Symptoms are frequent (usually occurring 12 times a month or more) and persistent, and include:

  • Persistent abdominal distension (women often refer to this as bloating)
  • Early satiety and/or loss of appetite
  • Pelvic or abdominal pain
  • Urinary urgency and/or frequency

Occasionally there can be other symptoms such as unexplained weight loss, unexplained fatigue, and unexplained changes in bowel habit. Any post-menopausal bleeding requires urgent investigation.

Symptoms of ovarian cancer are usually more persistent and frequent than similar symptoms caused by other conditions like Irritable Bowel Syndrome.

 

Risk Factors 

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.

Women with a family history (maternal or paternal) of not only ovarian but also breast cancer could be at greater risk of developing ovarian cancer.

Find out more about risk factors.

Diagnostic tests

NICE gives clear guidance on how to manage symptomatic women:

  • If physical examination identifies ascites and/or a pelvic or abdominal mass, refer urgently to gynae-oncology.
  • Women reporting persistent or frequent symptoms highly indicative of ovarian cancer should be given a serum CA125 test, particularly if they are age 50 or over.
  • Women age 50 or over presenting with new onset IBS should be given a serum CA125 test.
  • If the CA125 is greater than 35 IU/ml arrange an urgent ultrasound scan of the abdomen and pelvis.
  • 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 within one month if symptoms continue. If concerns persist refer urgently to gynae-oncology.

 

Scottish SIGN guidance and the Scottish referral guidelines for suspected cancer recommends performing abdominal palpation on women presenting with symptoms of ovarian cancer, and referring them for a CA125 serum test and urgent pelvic ultrasound scan. If the pelvic ultrasound is abnormal and/or the CA125 greater than 35 IU/ml women should be referred urgently to secondary care for further investigation.

Target Ovarian Cancer’s CA125 fact sheet and ultrasound fact sheet  are available for GPs and GP nurses to give women who are undergoing diagnostic tests. The fact sheets outline what the test is for, what to expect when having the test and what the results might mean.

Women undergoing tests for suspected ovarian cancer can contact our nurse-led support line on 020 7923 5475 for confidential support and information.

Patient having blood taken

Common problems diagnosing ovarian cancer

Nearly two thirds of women diagnosed with ovarian cancer will have late stage disease at the point of diagnosis. The challenge for primary care professionals is in the detective work required to identify suspected cases of ovarian cancer from cases of non-malignant disease.

  • Misdiagnosis: women presenting with symptoms of ovarian cancer often receive a diagnosis of IBS, diverticulitis, 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, in these cases serum CA125 should be measured.
  • Bloating: abdominal distention is a high-risk symptom, warranting rapid investigation (increased abdominal size/persistent bloating – not bloating that comes and goes). Women often using the word ‘bloating’ to describe 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.
  • ​Follow up consultation: women often fail to return for a follow up consultation even if their symptoms persist. Health care professionals should encourage women to book a follow-up consultation within one month if symptoms persist. Suggesting that patients keep a record of symptom frequency and persistency may help a follow up appointment, patients can download a copy of our Symptoms Diary to help them. 

Screening programmes

There is currently no national screening programme for ovarian cancer in the UK.
 
Two major clinical trials have assessed the impact of screening on ovarian cancer mortality both among women in the general population and among those at increased risk of ovarian cancer due to a family history. Both trials use and CA125 serum assay in an algorithm known as the Risk of Ovarian Cancer (ROCA) test which establishes an individual’s baseline levels of CA125, and reveals an individualised profile of change over time rather than relying on a single CA125 fixed cut off value. Transvaginal Ultrasound (TVU) is also used as part of the screening protocol

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. The trial was only for women without symptoms of ovarian cancer and not at high risk of developing the disease due to a strong family history of either breast or ovarian cancer.  

Results published in The Lancet show that the study's new approach to using the CA125 seum assay in the ROCA test may help reduce the number of women dying from ovarian cancer by around 20 per cent, but the study stopped short of recommending that a screening programme for ovarian cancer would save lives. 

At this stage there is not enough confidence that a screening programme would definitely impact mortality. Researchers will now conduct a follow-up to the trial for three more years to establish the full impact of ovarian cancer screening. Read more about UKCTOCS in our newstory.  

UKFOCSS: the United Kingdom Familial Ovarian Cancer Screening Study looked at whether regular screening is beneficial for women at high-risk of developing ovarian cancer. Over 4,000 women with a 1 in 10 or greater risk of developing ovarian cancer due to family history or known gene mutation took part in the study. The results were published in the Journal of Clinical Oncology and indicated that four-monthly screening with the Risk of Ovarian Cancer Algorithm (ROCA) may be an option for these women until they decide to undergo surgery, however, this has not yet be implemented.

Get trained up

We have a selection of free online learning modules hosted by BMJ Learning and RCGP elearning that will help you stay up-to-date on the latest ovarian cancer information.

Treating ovarian cancer 

Treatment options for ovarian cancer often involve surgery and chemotherapy. For some, it will not be curative but instead provide optimal disease management and help maintain best possible quality of life.

For more information visit our treatment pages.