Four red flag signs of 'vague' cancer as doctor warns early checks save lives

Researchers say fast-track testing can identify aggressive cancer making diagnosis quicker and giving a better chance of survival

Early testing of women for a killer cancer can spot the disease in time to save the lives of more than nine out of 10. Ovarian cancer kills 87% of those who are diagnosed in the advanced stages.

However researchers who carried out a study say if the disease is spotted early this can save the lives of 93% of women with it. According to Cancer Research UK, which part-funded the study, "symptom triggered testing" can make a major difference in the speed of a diagnosis.

But what should people be looking out for? The NHS says there are four main symptoms of ovarian cancer and six other things to watch for.

Symptoms of ovarian cancer include frequently (roughly 12 or more times a month) having:

• a swollen tummy or feeling bloated
• pain or tenderness in your tummy or the area between the hips (pelvis)
• no appetite or feeling full quickly after eating
• an urgent need to pee or needing to pee more often

Other symptoms of ovarian cancer can include:

• indigestion
• constipation or diarrhoea
• back pain
• feeling tired all the time
• losing weight without trying
• bleeding from the vagina after the menopause

Although the symptom triggered testing scheme has been in operation since 2011 it was unclear of the difference it made. Researchers from Birmingham University carried out their study to evaluate how effective it is.

They looked at data from 1,741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study across 24 UK hospitals. And they found a major improvement in survival chances for those who were diagnosed through the symptom triggered testing scheme.

Under the scheme the National Institute for Health and Care Excellence recommends that GPs should arrange ovarian cancer tests for women, some transgender men and non-binary people assigned female at birth who have the following symptoms 12 or more times a month – especially if they are over 50:

• swelling or bloating in the abdomen
• feeling full quickly or loss of appetite
• pain in the abdomen
• needing to wee more often or urgently

Patients are given a blood test that detects the levels of CA125 (a protein produced by ovarian cancer cells) and they may also be referred for an ultrasound scan. Abnormal results prompt a fast-track referral for hospital review by a gynaecologist within 2 weeks.

The researchers found that one in four women diagnosed through symptom triggered testing had stage 1 or 2 high grade serous ovarian cancer. Diagnosing these women early meant they had a much greater chance of surviving their cancer for five or more years than they would have if they were diagnosed at stage 3 or 4.

Women on the study with later stage cancers diagnosed through the symptom triggered testing pathway also benefitted from being fast-tracked. Most of them were eligible for surgery that completely or almost completely removed their tumours.

In total, surgery cleared all visible signs of cancer from two out of every three women diagnosed with high grade serous ovarian cancer after symptom triggered testing. Less than one in 10 women diagnosed in this way had cancers too advanced to be treated with surgery.

Cancer Research UK is now calling for more research into what diagnosis through the symptom triggered testing pathway means for patient outcomes over the longer term. Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham, the study’s senior author., said: “These findings challenge the assumption that [high grade non serous ovarian cancer] should always be considered to be in its advanced stages in women once they develop symptoms.

“More importantly, [they] emphasise the importance of increasing awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway.”

The charity said the value of the fast-track pathway for diagnosing high grade ovarian cancers in particular is linked to the fact they usually grow more quickly than lower grade ones. Finding them before they grow or spread too far means surgery can be done with the intention of removing as much of the tumour as possible, which is associated with longer survival. That helps show why NHS performance against cancer waiting times targets is so important.

Dr David Crosby, Cancer Research UK head of prevention and early detection, said: "It’s vital that the NHS has the resources to quickly diagnose and treat patients when they come forward. Highlighting the need for people with symptoms to talk to their GP he added: "Signs of ovarian cancer can often be vague, such as pain or bloating in the stomach.

"If you notice something that doesn’t feel right for you, it’s important to speak to your doctor. In most cases, it won’t be cancer, but it’s best to get it checked out.”