Practice Easily missed?

Ovarian cancer

BMJ 2009; 339 doi: (Published 18 November 2009) Cite this as: BMJ 2009;339:b4650
  1. William Hamilton, consultant senior lecturer1,
  2. Usha Menon, professor and consultant gynaecologist2
  1. 1Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol BS6 2AA
  2. 2Academic Gynaecological Oncology, UCL EGA Institute for Women’s Health, Maple House, London W1T 7DN
  1. Correspondence to: U Menon u.menon{at}

    Ovarian cancer is the leading cause of death from gynaecological cancer in the United Kingdom. Around 4400 deaths occur each year, and UK mortality figures are worse than comparable European ones.1

    Case scenario

    Susan was 52 when she first noticed symptoms of urinary urgency, then abdominal swelling and intermittent abdominal pain. Because at the time she was tearful and tired as a result of work difficulties, and urinalysis was normal, her general practitioner thought that she was depressed. After several more attendances, however, her abdomen was examined, and a mass was felt on vaginal examination. Rapid investigation, including transvaginal ultrasound and serum CA125, led to surgery and a diagnosis of stage III ovarian cancer.

    How common is it?

    • Just under 7000 new diagnoses are made each year in the United Kingdom

    • This equates to about one new diagnosis for each full time general practitioner every five years

    • About 85% of new cases are diagnosed in women over 50 years

    Why is it missed?

    The vagueness and non-specific nature of the symptoms, lack of serious pain or physical disability, and lack of awareness cause women to dismiss the symptoms as being related to normal body changes, such as the menopause, or to stress.2 The initial symptoms are often suggestive of benign gastrointestinal or urinary conditions, which are also much more common …

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