How to detect ovarian cancer: symptoms and diagnostic tests

The most common symptoms are persistent abdominal bloating that does not improve with dietary changes, chronic pelvic or abdominal pain, feeling full quickly when eating, an urgent or frequent need to urinate, changes in bowel habits and postmenopausal bleeding. What matters is that they are persistent, more than 12 days a month for more than 4 weeks, and represent a change from the usual pattern.

Because it does not cause specific symptoms in the early stages and there is no effective population screening programme. Screening with CA-125 plus ultrasound in the general population has not been shown to reduce mortality and produces many false positives. That is why 70% of cases are detected when there is already peritoneal spread.

Transvaginal ultrasound is the first imaging test (sensitivity of 80-90% in expert hands). It is complemented by the CA-125 marker (raised in 80% of advanced cancers, but of little use for screening), chest, abdominal and pelvic CT to assess extent and metastases, MRI for complex masses and, in selected cases, PET-CT or diagnostic laparoscopy.

CA-125 is raised in 80% of advanced epithelial cancers, but it can be normal in early stages and rise in benign conditions such as endometriosis, fibroids or pelvic inflammation. It is useful for follow-up and for detecting recurrences, but not for screening the general population.

The people at highest risk are carriers of BRCA1 or BRCA2 mutations (lifetime risk of 40-60%), women with two or more first-degree relatives with ovarian or breast cancer, carriers of Lynch syndrome, women with endometriosis (2-3 times higher risk) and women who have never been pregnant. The risk increases steadily after the menopause.

In BRCA1 carriers, bilateral prophylactic salpingo-oophorectomy is recommended from the age of 35-40 or once they no longer wish to have children. In BRCA2 it can be delayed until 40-45. This operation reduces the risk of ovarian cancer by 80-95% and also reduces the risk of breast cancer.

Yes. Abdominal bloating, a feeling of early fullness and changes in bowel habits are symptoms often mistaken for irritable bowel syndrome or food intolerance. If these symptoms are new, persist for more than 2-3 weeks and come with pelvic discomfort, it is important to rule out ovarian disease.

At present there is no effective screening test for the general population. However, in high-risk women (BRCA mutation, significant family history) regular surveillance with CA-125 and transvaginal ultrasound every 6 months is recommended, together with genetic counselling. Paying attention to persistent symptoms is still the main diagnostic tool.

The ROMA index combines CA-125 and HE4 values with the patient's menopausal status to estimate the risk that an ovarian mass is malignant. It is more specific than CA-125 alone and helps decide whether the patient should be referred to a centre specialising in oncological surgery.

You should see one if you have symptoms that persist for more than 2-3 weeks with no identifiable cause, if you have known risk factors (BRCA mutation, family history), if an imaging test has found a suspicious ovarian mass, or if you already have a confirmed diagnosis and want a specialist assessment of the treatment plan.

Yes. The quality of the initial surgery is the most important modifiable prognostic factor in ovarian cancer. An assessment by a specialised team before starting any treatment makes it possible to confirm the stage, review the surgical plan and access advanced techniques such as HIPEC when they are indicated. Our team offers a personalised assessment for each case.