Should I see an ovarian cancer specialist?

It can be very difficult for GP's to decide who may have a suspected cancer and who may have something much less serious that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if the symptoms get better or go away with treatment such as antibiotics. If GP's referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

If you have particular symptoms, your GP should refer you to a specialist straight away. NICE (The National Institute for Health and Clinical Excellence) have produced guidelines for GP's in England and Wales to help them decide which patients need to be seen urgently by a specialist. These Government guidelines on referrals for gynaecological cancer were revised in June 2005. In Scotland, the Scottish Executive referral guidelines for suspected cancer were published in February 2007.

Ovarian cancer symptoms can be vague. For this reason, NICE recommend that doctors examine any woman who has vague symptoms such as

• Tummy (abdominal) pain
• Swelling or bloating of your tummy (abdomen)
• Constipation
• Back pain
• Needing to pass urine more often than usual (frequency) or more suddenly than usual (urgency)

Then, if your GP is concerned, they should do a full pelvic examination. This will include an internal examination, if you agree to have one.

In April 2011, NICE issued more guidance for GPs about ovarian cancer.  They say that women who repeatedly go back to their GPs with these vague symptoms should be offered a CA125 blood test, particularly if they are over 50.  Based on the results of this test, if necessary your GP can arrange an ultrasound scan of your abdomen and pelvis - the area between your hip bones.  Your GP should also arrange an urgent ultrasound if he or she can feel a lump in your pelvis, and it doesn't feel like fibroids.  If an urgent scan appointment isn't available, or if the scan result shows any signs that could be due to ovarian cancer, you should see a specialist within 2 weeks.

According to NICE guidelines, if you have symptoms that could be due to ovarian cancer, you should ideally have an appointment with a specialist within 2 weeks (as an urgent referral). The main symptom that NICE say needs urgent referral is a suspicious looking lump seen on a pelvic ultrasound scan. But they do also say that, if an urgent scan isn't available, your GP should refer you urgently if you have the vague symptoms listed above and they have any cause for concern when they examine you.

If you are concerned that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

If you've been to the GP before with your symptoms, and they have not improved, you could ask your GP to refer you for an ultrasound, as these guidelines suggest.

You may also want to ask your doctor about having the CA125 blood test. This is a general test and can't diagnose ovarian cancer on its own.  But it can help to show that something may be wrong.  And NICE now recommend it if you have recurring vague symptoms, particularly if you are over 50 years old.

Remember - if you have a family history of ovarian cancer then your GP may be able to refer you to a family cancer clinic so that you can have your family history properly assessed.  You may then be able to have screening for ovarian cancer.