Should I see an ovarian cancer specialist?

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if the symptoms get better or go away with treatment such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

If you have particular symptoms, your GP should offer tests or refer you to a specialist straight away. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs in England and Wales to help them decide which patients need to be seen urgently by a specialist. These guidelines on referrals for ovarian cancer were updated in April 2011. In Scotland, the Scottish Executive referral guidelines for suspected cancer were published in February 2007.

Symptoms of ovarian cancer can be quite vague. The NICE guidelines say that your GP should offer you tests if you have any of the following symptoms which don’t go away or happen quite often (particularly if you are 50 or over)

• Tummy (abdominal) or pelvic pain
• Long lasting swelling or bloating of your tummy (abdomen)
• Needing to pass urine more often than usual (frequency) or more suddenly than usual (urgency)
• Loss of appetite or feeling full quickly

Your GP may also offer you tests if you

• Are feeling tired all the time
• Have lost weight for no obvious reason
• Have had a change in bowel habit (for example constipation or diarrhoea)

If you are 50 or over and have had symptoms similar to those of irritable bowel syndrome (IBS) during the last 12 months, your doctor should offer you tests for ovarian cancer. This is because it is unusual for women of this age to develop IBS for the first time.

Your doctor will ask to do a pelvic examination first of all. If you have a build up of fluid (ascites) or a lump in your abdomen or pelvis, and it doesn’t feel like fibroids, they will refer you urgently to a specialist. This should ideally be within 2 weeks.

Other tests your doctor may want to do include the CA125 blood test. Based on the results of this test, your GP can arrange an ultrasound scan of your abdomen and pelvis. If an urgent scan appointment isn't available, or if the scan result shows any signs that could be due to ovarian cancer, you should see a specialist within 2 weeks.

If your GP does not think that you have ovarian cancer, they will not refer you to a specialist but will ask you to go back to them again if your symptoms continue or happen more often.

According to the Scottish and NICE guidelines, your GP should refer you urgently (within 2 weeks) to see a specialist if

• You have a lump in your abdomen (tummy) or pelvis (unless your GP is certain it is fibroids)
• Your ultrasound scan shows a lump or abnormal area that could be ovarian cancer

The NICE guidelines also recommend that if you have a build up of fluid (ascites) in your abdomen, your GP should send an urgent referral.

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

If you've been to the GP before with your symptoms, and they have not improved or are happening more often, you could ask your GP for the CA125 blood test or to refer you for an ultrasound, as these guidelines suggest.

The CA125 blood test is a general test and can't diagnose ovarian cancer on its own.  But it can help to show that something may be wrong.  And NICE now recommend it if you have vague symptoms that are not improving, particularly if you are over 50 years old.

The Scottish guidelines also recommend having tests if you are over 45 and have abdominal pain or swelling that is not getting better.

Remember - if you have a family history of ovarian or breast cancer then your GP may be able to refer you to a family cancer clinic so that you can have your family history properly assessed.  You may then be able to have screening for ovarian cancer.