The cause of Karen’s symptoms

Having examined Karen, Dr McGoldrick discusses options which might explain her symptoms. At this point, it is important for GPs to consider cancer alongside other possible diagnoses.

Having reviewed the situation and identified the most likely cause, Dr McGoldrick has prescribed Karen a proton pump inhibitor (PPI) for a suspected ulcer and requested a stool sample to be tested for H. Pylori.

Other diagnoses to consider

	Irritable bowel syndrome (IBS) is a chronic disorder. It causes episodes of abdominal pain/discomfort, change in bowel habits, constipation, diarrhoea and bloating. Anxiety and stress can trigger it. Irritable bowel syndrome rarely presents for the first time in women aged 50 or above. Therefore, if a patient presents with ongoing irritable bowel syndrome, the NICE NG12 guideline recommends carrying out appropriate tests for ovarian cancer.
	Gastric ulcers can cause abdominal pain, bloating, nausea/vomiting and early satiety. However, sometimes complications from a gastric ulcer can be very serious and include bleeding, perforation and obstruction.
	Gastritis occurs when the lining of the stomach becomes inflamed. Gastritis is usually mild and resolves without any treatment. It can be described by the patient as heartburn.
	Endometriosis is a condition characterised by the growth of endometrial tissue outside the uterine cavity. It can present with abdominal/pelvic pain, bloating, dysmenorrhoea, dyspareunia and change in bowel habit.
	Colorectal cancer can have overlapping symptoms with ovarian cancer – including abdominal pain, change in bowel habits, and unexplained weight loss (NICE NG12). If a patient is referred to secondary care for suspected colorectal cancer, and test results are negative, alternative diagnoses should be investigated, including ovarian cancer. Patients should be told to return to their GP if their symptoms persist, change, or worsen.

Ruling out IBS

Irritable bowel syndrome (IBS) can commonly mimic the symptoms of ovarian cancer. Professor Gordon Jayson and Dr Rebecca Leon discuss how to differentiate between the two.

Additional resources

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