Just one in five women can name bloating as a main symptom of ovarian cancer (Table 1). Practice nurses are well placed to educate women about the symptoms of ovarian cancer and, with greater awareness, there's potential for people to seek help sooner, and therefore increase the possibility of a diagnosis being made at an earlier stage (National Cancer Registration and Analysis Service, 2019).
Table 1. Knowledge of the symptoms of ovarian cancer among UK women
| Symptom | Percentage of women who can name it as a symptom of ovarian cancer |
|---|---|
| Persistent bloating | 21% |
| Abdominal pain | 32% |
| Feeling full | 3% |
| Needing to wee more urgently | 1% |
The lack of awareness, combined with no sustained national awareness campaigns and no screening programme, means early diagnosis of this cancer is challenging as people may not know the symptoms to look out for or feel empowered to seek help if they arise.
This disease is killing 11 women a day (Cancer Research UK, 2022). That's a woman every 2 hours. Everyone in primary care can play a role in driving awareness, which could lead to an early diagnosis of ovarian cancer.
The teachable moment
Practice nurses are at the forefront of women's health. Contraception, sexual health advice, menopause management and cervical screening are some of the regular interactions nurses have with women. These are opportunities for educating women, ensuring they are equipped and empowered with knowledge to help them recognise cancer symptoms. Here, there's potential for lives to be saved.
These opportunistic symptom awareness conversations, built into the consultation, are a perfect teaching opportunity. A brief overview of the major symptoms of ovarian cancer could fit into any women's health review, particularly a cervical screening appointment. One out of five women mistakenly believe that a smear will detect ovarian cancer (Target Ovarian Cancer, 2019). This is a prime opportunity to have a conversation and inform a patient that cervical screening only picks up problems with the cervix, not ovaries, making symptom recognition even more vital.
How practice nurses can help with ovarian cancer awareness and early diagnosis
- Know the symptoms – which are often frequent, persistent and new:
- Persistent bloating – not bloating that comes and goes
- Early satiety and/or loss of appetite
- Pelvic or abdominal pain
- Urinary urgency and/or frequency.
- Know other symptoms that could indicate ovarian cancer:
- Weight loss
- Changes in bowel habit
- Unexplained fatigue
- Loss of appetite.
- If you or your patient are concerned, make an appointment with the GP and encourage them to start a symptoms diary. The GP should consider requesting a CA125 blood test and/or pelvic ultrasound scan.
- Read about how gene mutations and a family history of ovarian and/or breast cancer can be significant (Zhang et al, 2011; Lynch et al, 2013; Norquist et al, 2016). Up to 20% of cases of ovarian cancer can occur because of an inheritable genetic cause (Chandrasekaran et al, 2021).
- Be aware of common misdiagnoses: Ovarian cancer is commonly misdiagnosed as irritable bowel syndrome. National Institute for Health and Care Excellence (2021) guidance recommends that women age 50 years or over presenting with new IBS-like symptoms are referred for further investigations.
- Consider ovarian cancer in women with recurrent urinary tract infection but clear mid stream urine.
- Referral: Any person with a palpable mass should be referred on the 2-week pathway.
- Encourage women who have had a clear result for ovarian cancer to return for further tests if their symptoms persist.
Conclusion
Practice nurses have an important role to play in raising awareness of ovarian cancer symptoms with patients, as they are at the forefront of women's health. This article has provided information for practice nurses to aid in symptom recognition and early diagnosis. Target Ovarian Cancer have been at the forefront of early diagnosis in ovarian cancer for over a decade. Together we can improve outcomes for everyone diagnosed with ovarian cancer.
Useful resources
- Order Target Ovarian Cancer's leaflets, ovarian cancer guides and fact sheets for your practice (https://targetovariancancer.org.uk/support-for-you/our-guides-and-information-materials/order-guides)
- Join our GP network and receive the latest ovarian cancer news, tools and primary care recommendation (https://targetovariancancer.org.uk/health-professionals/GPs)
- Visit our website to access free online learning modules and recorded expert sessions (https://targetovariancancer.org.uk/health-professionals/nurses/events-and-training-opportunities)
- Target Ovarian Cancer symptoms diary. https://targetovariancancer.org.uk/health-professionals/GPs/resources-support-your-patients