Ovarian cancer: recognition and initial management

First steps

When you visit your GP with symptoms that are causing you concern, he or she should talk with you about them and offer you a physical examination.

Your GP should offer you tests if you have had one or more of the following symptoms for a while, or they occur frequently (particularly more than 12 times a month). This is especially the case if you are 50 or over. These symptoms are:

Other symptoms can also be associated with ovarian cancer. Your GP may offer you tests if you are constantly feeling very tired, have been losing weight for no obvious reason or have had changes in bowel habit (for example, constipation or diarrhoea).

If you are 50 or over and have had symptoms over the last 12 months that are similar to those of irritable bowel syndrome (IBS), your GP should offer you tests to check for ovarian cancer. This is because it is unusual for a woman of this age to develop IBS if they have not had it before.

Your GP should refer you urgently (within 2 weeks) to see a gynaecologist who specialises in cancer if they identify certain signs when they examine you. These include a build-up of fluid in your abdomen, or a lump in your abdomen or pelvic area that is not a result of fibroids.

If, after examining you and discussing your symptoms, your GP thinks that you do not have ovarian cancer, they should advise you to come and see them again if your symptoms continue or become more frequent.

Tests that your GP may do

If your symptoms suggest there is a chance that you could have ovarian cancer, your GP should offer you a blood test, to measure the levels of a protein called CA125 in your blood.

Having a high level of CA125 does not necessarily mean you have ovarian cancer. Levels of CA125 can also be raised in women who have other conditions, and some healthy women have naturally high levels. But if your CA125 is increased to a level that may suggest ovarian cancer, your GP should arrange for you to have an ultrasound of your abdomen and pelvis.

If the ultrasound suggests that further tests are needed, your GP should refer you urgently (within 2 weeks) to see a gynaecologist who specialises in cancer.

You should not be referred to a gynaecologist at this stage if your CA125 levels are normal, or if you have raised CA125 but the ultrasound does not indicate that further tests for ovarian cancer are needed. Your GP should check to see whether anything else may be causing your symptoms – this might involve other tests. If there is no apparent cause of your symptoms, your GP should advise you to come back to see them again if the symptoms continue or become more frequent.