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GPs Should Suspect Ovarian Cancer in All Women With Distended Abdomen, U.K. Researchers Warn

Posted by Paul Cacciatore on March 9, 2009

“GPs [General Practioners] should suspect ovarian cancer in all women presenting with abdominal distension, [U.K.] researchers have warned.  The primary care study found it was an important enough symptom on its own to warrant further investigation.  Researchers linked seven symptoms to ovarian cancer with many commonly present as much as six months before diagnosis, and warned that their study dispelled the myth that ovarian cancer was a ‘silent killer’. …”

“GPs [General Practioners] should suspect ovarian cancer in all women presenting with abdominal distension, researchers have warned.

The primary care study found it was an important enough symptom on its own to warrant further investigation.

Researchers linked seven symptoms to ovarian cancer with many commonly present as much as six months before diagnosis, and warned that their study dispelled the myth that ovarian cancer was a ‘silent killer’.

As many as 2.5% of women with abdominal distension on its own were subsequently diagnosed with ovarian cancer, and an ovarian cancer diagnosis was 240 times more likely in these women than in controls.

Urinary frequency and abdominal pain were also associated with risk, with the relative risk of ovarian cancer increasing by 16- and 12-fold respectively, although the positive predictive values of the symptoms on their own were only 0.2% and 0.3%.

Abdominal distension, urinary frequency and abdominal pain remained independently associated with cancer more than six months prior to diagnosis.

Dr. Willie Hamilton, a GP and a senior research fellow in primary care at the University of Bristol, said his preliminary results provided an evidence base for GPs to select patients for further investigation: ‘Abdominal distension is important enough to warrant investigation for ovarian cancer even without the need for other symptoms.’  ‘Ovarian cancer is not a silent killer, it’s just its noise seems to go unheard by GPs at times’, he added.

The study, presented at the Society for Academic Primary Care south west annual research meeting last week, examined the records of 212 women diagnosed with ovarian cancer at 39 practices in Devon in the year before diagnosis, and compared them with 1,030 matched controls.

Dr. Murray Freeman, a GP in Birkenhead, Merseyside and cancer lead for Wirral PCT, said the study ‘highlights how often ovarian cancer masquerades as other common illnesses’. ‘GPs should have a low index of suspicion in women over 40 with non specific symptoms – and refer or investigate early.’

Dr. Nick Brown, a GP in Chippenham, Wiltshire with an interest in cancer, said GPs desperately needed a tool to aid earlier diagnosis. ‘Small tumours are very difficult to diagnosis, even by doing a pelvic or vaginal examination. By the time tumours reach the size they can be detected it may have spread and treatment might not be that easy.’

Positive predictive values of ovarian cancer symptoms -

• Abdominal distensions – 2.5%
• Post-menopausal bleeding
• Loss of appetite – 0.6%
• Urinary frequency – 0.2%
• Abdominal pain – 0.3%
• Rectal bleeding – 0.2%
• Abdominal bloating – 0.3%

Source: Society for Academic Primary Care, South West Annual Research Meeting, March 2009, oral presentation”

Quoted SourceSuspect Ovarian Cancer In All Women With Distended Abdomen, by Lilian Anekwe, Pulsetoday.co.uk, Mar. 9, 2009.

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3 Responses to “GPs Should Suspect Ovarian Cancer in All Women With Distended Abdomen, U.K. Researchers Warn”

  1. I had an ovarian scan February 2012 my CA 125 was 30 in March, it’s 34 in June and I’m still waiting to be seen!!! We have made the decision to go private and I am seeing a specialist next week.
    My risk is increased due to IVF in 2006 and I am over 40. My stomach is distended and I look pregnant, I’m in pain continuously.
    It’s all good and well having the knowledge but it’s of no importance when the NHS refuse to see you.

  2. Janet MacNeven said

    I have a friend, that all of a sudden had a distended stomach/abdomen area that looked like she was pregnant over night. She did not gain any weight, but looked pregnant. Then it went away within days. She did not experience gas like symptoms, but did have pain in the abdomen. She went to the ER and they did tests. She is awaiting results from a CT Scan. Any thoughts about this?

    • Hi Janet,

      Thank you for visiting Libby’s H*O*P*E*. We suggest that you wait for the results of the CT scan. Any evaluation of a patient must be based on the totality of the facts, including patient medical history (e.g., age and prior gynecological and gastrointestinal issues), family medical history (both maternal and paternal), blood test results, scans, etc. As a general matter, the bloating symptom associated with ovarian cancer tends to be persistent over an extended period of time (e.g., several weeks). Your friend may want to discuss with her doctor the potential benefits, if any, associated with a transvaginal ultrasound and a CA-125 blood test, assuming that neither has already been performed. However, the decision to perform additional testing must be evaluated in light of the pending CT results.

      It is important to keep in mind that ovarian cancer is a rare disease within the general population. This lifetime risk is potentially affected by several factors, including: age, family history (both maternal and paternal) of ovarian, breast and/or colon cancer, Ashkenazi (Eastern European) Jewish ancestry, early onset of menstruation, late onset of menopause, number of pregnancies, use of oral contraceptives, etc.

      It seems that your friend is under a doctor’s care so he or she should be able to get to the bottom of these symptoms. If your friend is still experiencing persistent symptoms for several weeks after this evaluation, she should see an ob/gyn and discuss the symptoms with him or her. For an extended list of early ovarian cancer warning signs, click here.

      We hope that the information presented above is helpful. If you have additional questions, please feel free to contact us.

      Best regards,
      Paul Cacciatore
      Founder, Libby’s H*O*P*E*

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