Patient profile

Karen Smith is a 54-year-old mum with four children and has been married to her husband Tim for almost thirty years. She is a full-time carer for her youngest child Adam, 16, who has cerebral palsy. Prior to looking after Adam, Karen worked as a support worker for most of her career. As you watch the consultation, make notes about Karen’s symptoms to compare with the information in the drop-down below.

Karen attends her first appointment with Dr McGoldrick

Karen presented with persistent/frequent bloating. NICE NG12 guidelines recommend taking a CA125 measurement to rule out ovarian cancer. A potential missed diagnostic opportunity can occur if this test is not undertaken.

Dr McGoldrick then went on to carry out a physical examination and he was unable to palpate an abdominal mass. However, if an abdominal mass was palpated, then the NICE NG12 guideline recommends making “…an urgent referral to a gynaecological cancer service if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).”

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Summary of symptoms

• Bloating
• Frequent sharp pain in her upper-abdomen for 3 – 4 months
• Poor appetite due to pain
• Weight gain
• Fatigue
• Frequent and loose bowels

Additional resources

Link: Suspected cancer: recognition and referral, NICE (2020)
Link: Ovarian cancer, BMJ Best Practice (2020)