Ovarian Cancer

Ovarian cancer is the fifth most common cancer among women in the UK, with about 7300 new cases each year (Cancer Research UK 2016). The risk of developing ovarian cancer is very low in young women and increases as women get older. More than 8 out of 10 (80% of) ovarian cancers occur in women over the age of 50 (Macmillan Cancer Support May 2015).

Ian Jacobs, a professor of gynaecological oncology, explains that the symptoms tend to be vague and non-specific and are common to many other, less serious, conditions, and that most women with these symptoms turn out not to have cancer.

The three most common symptoms of ovarian cancer are:

• Bloating that is persistent and does not come and go
• Difficulty eating and feeling full more quickly
• Abdominal or pelvic pain that is experienced most days

These symptoms are frequently experienced by women, however when they are experienced frequently, persistently and severely the likelihood of ovarian cancer increases (Ovacome 2016).

Other symptoms include:

• Needing to pass urine more often or more urgently (feeling like you can't hold on);
• Loss of appetite;
• Nausea;
• Unexplained weight change;
• Pain in the lower abdomen or back;
• Abnormal vaginal bleeding;
• Pain during sex;
• Changes in bowel or bladder habit such as constipation or diarrhoea, and
• Breathlessness.

Most women with ovarian cancer have only some of the symptoms, or may not notice any for some time.

 A lot of women we interviewed stressed that they did not think anything was seriously wrong because the symptoms are vague and tended to come and go or ease off after a while. Some women described a 'niggle' on one side, had a dull ache or tenderness or felt 'heavy in the pelvis' while others were alerted by definite lumps, sharp pains or a cramping feeling with bowel movements. One woman said she woke up feeling 'as if a balloon had popped in my tummy', another described a strange feeling that 'the usual muscles that (move your bowel or empty your bladder) aren't doing what you want them to do'. Some said that only when looking back did they realise that minor, vague symptoms were probably connected to their cancer.

Women usually attributed their symptoms to other causes such as mid-life changes. Many noticed that their waists had got bigger but blamed mid-life weight gain and just bought larger clothing or garments with elasticated waists. However, others were aware that this was not normal weight change - one said that she was the same weight but had just changed shape around her abdomen, and several said that they had looked pregnant. Others attributed their symptoms to stress, irritable bowel syndrome, ovarian cysts or fibroids. A few thought they might have bowel cancer.

GPs sometimes suspected these causes, or appendicitis, inflammation or infection of the gut, gall bladder problems or weakened pelvic floor muscles, and treated the symptoms accordingly, sometimes for long periods before investigating them. GPs can find it difficult to judge when to arrange tests as they may see only a handful of cases of ovarian cancer during their career. As many of the symptoms of ovarian cancer involve the gut neither women nor GPs may consider a gynaecological cause.

Many women said that they went to see their GP because they were about to go on holiday, or because their partners, colleagues or family told them they should. Some women were angry that their GPs assumed that their symptoms were hormonal and had not investigated further. However, as one reflected, the symptoms were very vague and 'You don't go running to the doctor at the first sign of something'.

Some women said that they 'just knew' something was seriously wrong and their doctors referred them quickly. One said she just swelled up overnight and her doctor arranged a scan straight away. Others described how quickly their GP, or in some cases a practice nurse, had acted.

Some women presented with an abdominal lump which their doctor suspected was a cyst or fibroid. Such lumps require further investigation and possibly biopsy and/or surgical removal to confirm whether they are benign or malignant. Some women went into hospital as an emergency because their GP had not recognised that their condition was serious, or while they were waiting for investigations.

In a few women who reported no symptoms, the disease was discovered during other medical investigations such as for infertility, or (very unusually) through cervical screening. The cervix is the neck of the womb and not near the ovaries. Cervical screening tests are not designed to detect ovarian abnormalities, and a normal cervical screening result does not exclude ovarian cancer. Neither is a pelvic examination (sometimes done at the same time as cervical screening) a reliable test for ovarian cancer.

Since we interviewed these women NICE (National Institute for Health and Care Excellence - 2015) has given guidelines to GPs suggesting they should arrange an urgent appointment (within two weeks) with a specialist in ovarian diseases (a gynaecologist) for any woman who comes with fluid (ascites) or a lump in the pelvis (unless your GP is sure that it is a lump called a fibroid in the womb; fibroids are not cancer and do not need an urgent referral).

The guidelines also recommend that GPs carry out tests if you are over 50 and have any of the following symptoms on a persistent basis: bloating or swelling of the abdomen, feeling full and/or loss of appetite, pelvic or abdominal pain, or increased urinary urgency and/or frequency.