This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
The symptoms that currently prompt referral for suspected ovarian cancer may be most common in women with later disease. Research found that gastrointestinal symptoms, such as indigestion (dyspepsia), may be a sign of early ovarian cancer.
Researchers compared the symptoms of women with fast-growing, early stage disease (picked up by potential screening tests such as blood tests or ultrasound), with those of women whose cancer was diagnosed later.
Abdominal symptoms were the most common in both groups but the researchers found that women with fast growing cancers picked up by screening tests reported:
- more gastrointestinal issues, such as changes in bowel habits and indigestion
- more general symptoms, such as tiredness
- fewer gynaecological symptoms, such as vaginal bleeding
Half of these women had more than one symptom.
The researchers say that more research is needed into symptoms that could suggest early cancer of the ovaries and fallopian tubes in postmenopausal women.
More information on ovarian cancer can be found on the NHS website.
The issue: what are the early signs of ovarian cancer?
The UK National Screening Committee reviewed the evidence for ovarian cancer screening in 2017, and found that screening did not reduce deaths from this disease. There is therefore no national screening programme for ovarian cancer.
In the UK, almost 7,500 women are diagnosed with cancer of the tubes and ovaries each year. Most (60%) have fast-growing disease (high-grade serous cancer) which often starts in the lining of the tube. Research suggests that these cancers can remain in an early stage for more than 4 years.
Certain high alert symptoms (persistent abdominal bloating, loss of appetite, feeling full, pain in abdomen or pelvis, increased urinary urgency or frequency) are known to suggest cancer in older women. National Institute for Health and Care Excellence (NICE) guidelines advise that women with these symptoms need further tests to rule out ovarian cancer. But symptoms are not specific to ovarian cancer and diagnosis is often delayed.
The list of high alert symptoms was derived mainly from women with late-stage disease. Information on symptoms in women with early fast-growing serous cancer is limited.
Researchers therefore examined data from the large UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), which previously assessed screening tests for ovarian cancer. It included more than 200,000 postmenopausal women aged 50 – 74. Half were screened annually; half were not screened (control group) and they were all followed up almost 10 years after the end of screening.
What’s new?
This study analysed data from 1,133 postmenopausal women who developed invasive epithelial ovarian cancer in the UKCTOCS trial. Most were white (98%) and had fast-growing high grade serous cancers (85%).
Overall, 162 women had early, fast-growing cancers. Abdominal symptoms were the most common symptoms both among the 67 women identified by screening and the 95 identified by a doctor.
However, among the women with early, fast-growing tumours identified by screening, many had other symptoms. The research found that:
- 1 in 3 (35%) of these women had gastrointestinal symptoms, such as changes in bowel habits and indigestion (dyspepsia)
- 1 in 4 (27%) had general symptoms, such as tiredness
- few (8%) had gynaecological symptoms, such as vaginal bleeding
- half the women reported more than one symptom.
Why is this important?
The findings suggest that symptoms which currently prompt further tests for ovarian and tubal cancers may be more common in later disease. Women with earlier cancers may have different symptoms. The authors urge clinicians to consider the possibility of ovarian cancer in postmenopausal women with more than one new symptom that includes a change in bowel habits, indigestion or general tiredness.
What’s next?
The researchers caution that symptoms need to be confirmed in larger analyses with a more diverse population and evaluated in a prospective trial.
They call for clinicians to use the new cancer referral pathway for non-specific symptoms. It is being set up by local NHS Cancer Alliances in response to NICE guidelines and the NHS Faster Diagnosis framework.
Understanding the symptoms of ovarian cancer could speed up diagnosis and improve women’s experiences of care. But screening in the UKCTOCS trial did not reduce deaths. Tests that detect ovarian cancer before women have symptoms are urgently needed.
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You may be interested to read
This is a summary of: Dilley J, and others. Ovarian cancer symptoms in pre-clinical invasive epithelial ovarian cancer – An exploratory analysis nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Gynecologic Oncology 2023; 179: 123 – 130.
A podcast and video about the UKCTOCS trial by the Medical Research Council Clinical Trials Unit.
Information on non-specific features of cancer from NICE.
Information on Faster Diagnosis of Cancer from NHS England.
Information and support regarding ovarian cancer from Cancer Research UK.
Information on taking part in NIHR research on ovarian cancer.
Funding: This study was funded by the NIHR Health Technology Assessment programme.
Conflicts of Interest: Multiple authors report receiving fees and funding from pharmaceutical companies. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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