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Suspect ovarian cancer in all women with distended abdomen

By Lilian Anekwe

GPs should suspect ovarian cancer in all women presenting with abdominal distension, researchers have warned.

The primary care study found it was an important enough symptom on its own to warrant further investigation.

Researchers linked seven symptoms to ovarian cancer with many commonly present as much as six months before diagnosis, and warned that their study dispelled the myth that ovarian cancer was a ‘silent killer'.

As many as 2.5% of women with abdominal distension on its own were subsequently diagnosed with ovarian cancer, and an ovarian cancer diagnosis was 240 times more likely in these women than in controls.

Urinary frequency and abdominal pain were also associated with risk, with the relative risk of ovarian cancer increasing by 16- and 12-fold respectively, although the positive predictive values of the symptoms on their own were only 0.2% and 0.3%.

Abdominal distension, urinary frequency and abdominal pain remained independently associated with cancer more than six months prior to diagnosis.

Dr Willie Hamilton, a GP and a senior research fellow in primary care at the University of Bristol, said his preliminary results provided an evidence base for GPs to select patients for further investigation: ‘Abdominal distension is important enough to warrant investigation for ovarian cancer even without the need for other symptoms.

‘Ovarian cancer is not a silent killer, it's just its noise seems to go unheard by GPs at times', he added.

The study, presented at the Society for Academic Primary Care meeting south west annual research meeting last week, examined the records of 212 women diagnosed with ovarian cancer at 39 practices in Devon in the year before diagnosis, and compared them with 1,030 matched controls.

Dr Murray Freeman, a GP in Birkenhead, Merseyside and cancer lead for Wirral PCT, said the study ‘highlights how often ovarian cancer masquerades as other common illnesses'.

‘GPs should have a low index of suspicion in women over 40 with non specific symptoms – and refer or investigate early.'

Dr Nick Brown, a GP in Chippenham, Wiltshire with an interest in cancer, said GPs desperately needed a tool to aid earlier diagnosis.

‘Small tumours are very difficult to diagnosis, even by doing a pelvic or vaginal examination. By the time tumours reach the size they can be detected it may have spread and treatment might not be that easy.'

Positive predictive values of ovarian cancer symptoms

• Abdominal distensions – 2.5%
• Post-menopausal bleeding
• Loss of appetite – 0.6%
• Urinary frequency – 0.2%
• Abdominal pain – 0.3%

Source: Society for Academic Primary Care, South West Annual Research Meeting, March 2009, oral presentation
• Rectal bleeding – 0.2%
• Abdominal bloating – 0.3

Dr Willie Hamilton: said his preliminary results provided an evidence base for GPs to select patients for further investigation Dr Willie Hamilton: said his preliminary results provided an evidence base for GPs to select patients for further investigation

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