What are the key symptoms and signs that should prompt me to consider ovarian cancer in a patient?

Key symptoms and signs that should prompt consideration of ovarian cancer include:

• Persistent or frequent abdominal distension (bloating), especially if occurring more than 12 times per month. This symptom is particularly significant in women aged 50 years and over and warrants further investigation NICE CG122,NICE CKS,NICE NG12.
• Pelvic or abdominal pain that is persistent or frequent, again especially in women aged 50 and over, should raise suspicion of ovarian cancer NICE CG122,NICE CKS,NICE NG12.
• Feeling full quickly (early satiety) and/or loss of appetite are important symptoms to consider, as they may indicate ovarian malignancy NICE CG122,NICE CKS.
• Increased urinary urgency and/or frequency on a persistent or frequent basis is another symptom associated with ovarian cancer NICE CG122,NICE CKS.
• Ascites or a pelvic or abdominal mass detected on physical examination (which is not obviously due to uterine fibroids) is a critical sign that requires urgent referral via a suspected cancer pathway NICE CKS,NICE CG122,NICE CKS,NICE NG12.
• Unexplained weight loss, fatigue, or changes in bowel habit may also be present and should prompt consideration of ovarian cancer and further assessment NICE CG122,NICE CKS,NICE NG12.
• New symptoms suggestive of irritable bowel syndrome (IBS) in women aged 50 or over should prompt testing for ovarian cancer, as IBS rarely presents for the first time at this age NICE CG122,NICE CKS.

In primary care, NICE recommends measuring serum CA125 in women presenting with these symptoms, with a threshold of 35 IU/mL or greater prompting urgent ultrasound imaging of the abdomen and pelvis NICE CKS,NICE CG122. If ultrasound findings suggest ovarian cancer, urgent referral to a gynaecological cancer service is indicated NICE CKS,NICE CG122.

These clinical features align with the literature emphasizing the often vague and nonspecific nature of early ovarian cancer symptoms, which include abdominal bloating, pelvic pain, early satiety, and urinary symptoms Teneriello & Park 1995Rooth 2013Matulonis et al. 2016. Early detection is challenging due to symptom overlap with benign conditions, underscoring the importance of symptom frequency and persistence as highlighted in the guidelines.