Picture Forum: Ovarian cancer Guidelines ignore 'key symptom'

Ovarian cancer diagnosis guidelines do not mention abdominal distension

Carcinoma cells in the human ovary. The condition is known as endometrioid carcinoma because these cells resemble carcinoma of the uterus. Two types of cells are seen in this coloured scanning electron micrograph: some ciliated cells with tufts of cilia (yellow) and abundant secretory cells with microvilli (purple)

Ovarian cancer cases are being missed because diagnosis guidelines do not mention abdominal distension, the symptom most likely to be associated with the cancer, a study suggests. Researchers from the University of Bristol examined the symptoms that could indicate ovarian cancer in women presenting to primary care. They then calculated the chance that a woman with a particular symptom actually had the cancer. They found that six symptoms associated with ovarian cancer had a positive predictive value below 1 per cent. These were urinary frequency, abdominal pain, postmenopausal bleeding, loss of appetite, rectal bleeding and abdominal bloating. However, abdominal distension, which is not included in NICE referral guidelines for suspected cancer, had a positive predictive value of 2.5 per cent. The authors conclude that abdominal distension is 'a common important symptom and warrants rapid investigation'.

Hamilton W, Peters TJ, Bankhead C et al. Risk of ovarian cancer in women with symptoms in primary care: population based case-control study. BMJ 2009; 339: b2998.

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