Going to the GP with symptoms during the COVID-19 periodIf you are experiencing one or more of the symptoms of ovarian cancer, don't let the COVID-19 pandemic put you off contacting your GP. It’s still important to get them checked out by your doctor. GPs and hospitals are still open for business and have put measures in place to make sure they can see you as quickly and safely as possible. In most instances, you will be assessed on the phone or via video, and offered a follow up appointment if necessary.
Please don’t sit on anything if you’re worried. Whatever is causing your symptoms, it’s best to get it seen to and diagnosed early. Track your symptoms so your GP can see how persistent and severe they are and to make it easier we've produced a symptoms diary. Download a paper copy here to print.
The British Gynaecological Society has written some helpful and reassuring guidance for women who are experiencing symptoms either for the first time or following an ovarian cancer diagnosis. You can read their guidance here.
Make an appointment to see your GP
If you are experiencing any of the four possible symptoms of ovarian cancer – persistent bloating, persistent stomach pain, difficulty eating or feeling full more quickly, and needing to wee more urgently or frequently – then you should make an appointment with your GP.
- At the GP surgery
At your appointment the GP should take a history of your symptoms, their severity and frequency. It would also be useful to tell them about any family history of breast or ovarian cancer. They should then conduct a physical examination of your abdomen to feel for anything unusual, and they may also do an internal vaginal examination.
If they are concerned that your symptoms could be caused by something like ovarian cancer they should then refer you for a CA125 blood test.
- If your CA125 test comes back positive
CA125 is a protein that all women have in their blood. Usually a woman’s blood level will be less than 35 units per millilitre (U/mL). A blood test that shows an elevated level could be a sign of a number of things including a chest infection, pregnancy and in some cases ovarian cancer.
A CA125 blood test can be carried out at your doctor’s surgery if they have the facilities, or you will be referred to your local hospital the same way you would for any other blood test.
Having a raised level of CA125 is not a diagnosis of ovarian cancer, but it should lead to further investigations. These will usually be in the form of a referral for an ultrasound scan.
- Having an ultrasound scan
Ultrasound scans usually take place in the radiology department of your local hospital and are used to produce a picture of what’s happening inside the body to help identify any unusual lumps or masses. There are two types: abdominal and transvaginal. A scan will typically take between 15 and 45 minutes.
An abdominal ultrasound scan involves a small handheld probe is placed on your skin and moved over the abdomen and pelvic area. This produces images of your ovaries, womb and other internal organs.
A transvaginal ultrasound scan involves a small probe being inserted into the vagina. This allows a closer look at things such as the ovaries, womb and fallopian tubes.
An ultrasound scan cannot diagnose ovarian cancer by itself, but if anything unusual is found you will be referred for further investigation by a specialist gynaecology doctor.
- Being referred to a specialist for further investigation
If the results of your ultrasound scan indicate that you require further tests you will be referred to a gynaecologist or gynaecological oncologist. They will arrange for you to have some explorative surgery to establish if you have ovarian cancer. Surgery will either be keyhole or open.
Keyhole surgery (laparoscopy) is performed by the gynaecologist using a flexible tube with a camera on the end. It is inserted via a small incision in the abdomen, and transmits images for the gynaecologist to analyse.
Open surgery (laparotomy) is an operation performed by a surgeon via a large incision in your abdomen, usually under general anaesthetic. This allows the surgeon to remove tissue and anything growing around the ovary to be sent for testing. If they find an obvious tumour they will attempt to remove this, which may involve removal of the ovary, or ovaries, fallopian tubes and other organs situated in the pelvic region.
During these procedures the surgeon will remove tissue from the ovary and take biopsies in order to determine whether or not you have ovarian cancer.
- What if my CA125 blood test and ultrasound scans are normal?
If your CA125 blood test and/or ultrasound scans come back normal it is unlikely that you have ovarian cancer. However it is important to continue to monitor your symptoms and return to your GP to find out what else they can do to help find out what is causing them.
Things other than ovarian cancer that could present with symptoms such as bloating, stomach pain, difficulty eating and weeing more frequently include irritable bowel syndrome (IBS); urinary tract infections; pulled muscles; pregnancy; gastro infections; indigestion; gallstones and the onset of the menopause.
Your GP should continue to investigate to see if your symptoms are linked to any of the above, or something else.
- Being diagnosed with irritable bowel syndrome
If after visiting your GP you are told you have IBS there are some things to consider before accepting that this is the case.
If you are over the age of 50 and have never experienced IBS before then it is unlikely that you will start to develop it now. Generally IBS develops in people during their 20s and 30s.
In order to establish with confidence that your symptoms are being caused by IBS, guidelines say that your GP should rule out other problems first by referring you for the following tests: a full blood count, testing for coeliac disease, and other more specific tests of things called c-reactive protein and erythrocyte sedimentation rate.
- If you feel you’re not being taken seriously
It is important to remember that GPs see the common symptoms of ovarian cancer multiple times a day, and the majority of the time there will be a more common cause.
However, if you feel your symptoms persist and get worse, and the things that your GP is suggesting are not being effective you can consider the following options:
- Ensure your symptoms diary is filled in as comprehensively as possible so you are giving your GP as much information as you can.
- Take someone with you to your appointment for moral support, and to help reinforce the impact and severity of your symptoms
- You’re always entitled to a second opinion so ask if another GP can be bought into the consultation
- If you usually see the same GP try and see a different one at your next appointment and explain everything from the start to them
- If you are still having problems you could also visit your local walk-in centre
- Can I be screened for ovarian cancer?
There is no national screening tool for ovarian cancer. A common misconception is that cervical screening, or the smear test, is used to diagnose ovarian cancer. This is not the case; the smear test is used to detect abnormal cells in the cervix that could lead to cervical cancer.