Ovarian cancer is the sixth most common cancer for in women in the UK, with around 7,400 diagnoses each year. Most women are diagnosed at advanced stages of the disease.

Signs and symptoms

Typical symptoms can include:

• Abdominal/pelvic pain, which is frequent and persistent (particularly if occurring more than 12 times a month)
• Abdominal distension/bloating
• Rumbling tummy (borborygmi)
• Nausea/vomiting
• A feeling of fullness (early satiety)
• Change in bowel habit or symptoms of IBS, especially if this starts after the age of 50
• Increased micturition urgency/frequency

Physical findings can include ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).

Less common symptoms include

• Vaginal bleeding (usually implies endometrial cancer)
• Leg swelling/DVT (consideration to investigate for a pelvic malignancy)
• Other vague symptoms include fatigue and unintentional weight loss

Investigations

• 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
• Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer
• The NICE NG12 guideline recommends measurement of CA125 if a woman aged 50 or above presents with new onset IBS symptoms
• If CA125 measurement is 35IU/ml or greater, then arrange a transvaginal ultrasound. If this is not possible, an ultrasound of the abdomen and pelvis should be organised, as per NICE NG12 guidelines
• It is recommended that the gold standard investigation is a CA125 and a transvaginal ultrasound
• 25% of ovarian cancers will have a normal CA125 level
• Check family history of breast, colorectal and endometrial cancers

Ovarian Cancer – Course Summary PDF

Click here to download a copy of the course summary.