Symptom triggered testing helps doctors diagnose ovarian cancer early

By Tim Gunn

Testing women with symptoms that could be linked to ovarian cancer is an effective way of finding aggressive forms of the disease in their early stages, according to research we helped fund.  

The NHS has offered this type of rapid symptom triggered testing for ovarian cancer since 2011. But, until now, it wasn’t clear how well this approach helped doctors find high grade serous ovarian cancer, the most common and aggressive form of the disease, at stage 1 or 2, when treatment is most likely to be effective.  

What is symptom triggered testing?

The NICE - 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

Those on the symptom triggered pathway 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.

To find out more, researchers led by a team at the University of Birmingham analysed data from 1,741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study across 24 UK hospitals. 

They found that 1 in 4 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 5 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 2 out of every 3 women diagnosed with high grade serous ovarian cancer after symptom triggered testing. Less than 1 in 10 women diagnosed in this way had cancers too advanced to be treated with surgery.

This suggests that increasing awareness of possible ovarian cancer symptoms can help ensure more people receive the best available treatments. We’d now like to see more research into what diagnosis through the symptom triggered testing pathway means for patient outcomes over the longer term. 

“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,” said Sudha Sundar , Professor of Gynaecological Cancer at the University of Birmingham, the study’s senior author. 

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

Discussing symptoms with your doctor:

If something isn’t normal for you, get it checked out. Even if you’ve seen someone before, if something still doesn’t look or feel quite right, make another appointment.

Your doctor will want to hear about any unusual changes you’re experiencing. You won’t be wasting their time.

Read more tips for talking to your doctor.

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.

“It’s vital that the NHS has the resources to quickly diagnose and treat patients when they come forward,” said Dr David Crosby , our head of prevention and early detection, who also highlighted the importance of talking to your GP if you experience any concerning symptoms. 

“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.” 

The overall is funded by the National Institute of Health Research. We fund the ROCkeTS-GEN arm of the study, which is focused on finding an alternative to the CA125 blood test, through our Stand up to Cancer fundraising campaign.