Persistent Bloating & Ovarian Cancer Signs

Most symptom advice says "persistent" and leaves it there. The NHS does not.

Its ovarian cancer page defines the main symptoms as ones occurring frequently, which it quantifies as roughly 12 or more times a month. Four are named:

• A swollen tummy, or feeling bloated.
• Pain or tenderness in the tummy, or in the area between the hips.
• No appetite, or feeling full quickly after eating.
• An urgent need to pee, or needing to pee more often.

It lists other symptoms too: indigestion, constipation or diarrhea, back pain, constant tiredness, unexplained weight loss, and unusual vaginal bleeding, including between periods, heavier periods, or bleeding after the menopause.

NCI's list overlaps almost exactly. Pain, swelling or a feeling of pressure in the abdomen or pelvis. Urinary urgency or frequency. Difficulty eating or feeling full. A lump in the pelvic area. Gas, bloating or constipation. NCI then adds the sentence that explains why this page exists: these symptoms often go unrecognized, which delays diagnosis.

There is a version of abdominal swelling that cannot wait, and it has nothing to do with how long the bloating has been going on.

MedlinePlus describes intestinal obstruction, a partial or complete blockage of the bowel. Its symptom list is abdominal swelling, abdominal fullness and gas, cramping pain, breath odor, constipation, diarrhea, inability to pass gas, and nausea and vomiting.

It names four reasons to contact a provider:

• Being unable to pass stool or gas.
• A swollen abdomen that does not go away.
• Vomiting that keeps happening.
• Unexplained abdominal pain that does not go away.

MedlinePlus also describes what treatment looks like, which is worth knowing because it explains the urgency. A tube is passed through the nose into the stomach or intestine to relieve the swelling and vomiting. Surgery may be needed if the tube does not work, or if there are signs of tissue death.

The NHS builds this into its advice rather than leaving it to the patient to insist. It says to see a GP if any ovarian cancer symptoms are present, and separately, to go back if symptoms have not gone away, are worse, or are more frequent than at the last visit.

That second clause is the one that matters. A first visit that ends in reassurance is not the end of the pathway if the symptoms carry on. The NHS is also explicit that these symptoms are very common and can be caused by many different conditions, and that getting them checked still matters. Both things are true at once.

For the general version of this problem, see a symptom is not a diagnosis and how to return to a doctor about a persistent symptom.

The NHS describes it step by step, which takes some of the dread out of it.

The GP asks about health and symptoms, and specifically about whether anyone in the family has had ovarian or breast cancer. A blood test may be arranged for CA-125, a protein sometimes linked to ovarian cancer. If the level is high, an ultrasound scan of the abdomen and pelvis follows.

There may also be an examination. The NHS explains that it can involve a speculum, and is honest about what that achieves: a speculum cannot detect ovarian cancer, but it can check for other causes of symptoms. The rest is pressing on the tummy and internally, feeling for lumps or tender areas. The NHS adds three things people are often not told. A female doctor or nurse can be requested at booking. A friend, relative or member of staff can be in the room. And discomfort should be said out loud.

A written count does more work than a description from memory, because the NHS threshold is a frequency.

Four columns cover it. The date. Which of the four main symptoms occurred. How bad it was. And whether anything was taken for it, and whether that helped. Over a month that produces a number, and the number is what a GP can act on.

Two extra facts belong on the same page. Whether anyone in the family has had ovarian or breast cancer, since the NHS says to volunteer that. And whether these symptoms are genuinely new, since NCI's framing rests on a change from how things were before.

The same blood test that investigates symptoms fails completely as a screening tool, and the evidence is unusually clear.

The PLCO trial screened women aged 55 to 74 at average risk with CA-125 at a threshold of 35 U/mL for six years, plus transvaginal ultrasound for four. After a median 17 years of follow-up there was no reduction in ovarian cancer deaths. The British UKCTOCS trial tested ultrasound alone and a multi-step CA-125 approach over a median 16.3 years, and found no mortality benefit from either.

The harm is measurable. In the ultrasound-only arm of UKCTOCS there were 50 false-positive operations per 10,000 screens.

On 13 February 2018 the USPSTF issued a Grade D recommendation against screening asymptomatic women who are not known to carry a high-risk hereditary syndrome. It also noted why symptom-based selection is so hard: abdominal pain or pressure, bloating, constipation, urinary symptoms, back pain and fatigue are all nonspecific, and turn up in healthy women as well as in women with late-stage disease.

That gap is the whole reason a frequency count matters. Nothing finds this cancer early in people without symptoms, so the pattern of symptoms is what there is to work with.

• Call 911 or go to an emergency department if nothing is passing — no stool and no gas — and your abdomen is swollen and cramping while you keep vomiting. MedlinePlus lists that combination under intestinal obstruction.
• Call your care team the same day if your tummy stays swollen and will not go down, or abdominal pain you cannot explain carries on without easing.
• Call your care team within a day or two if bloating, early fullness, pelvic pain or urinary urgency are happening on most days, or if any of them came back worse after a visit that ended in reassurance.

• https://www.nhs.uk/conditions/ovarian-cancer/symptoms/
• https://medlineplus.gov/ency/article/000260.htm
• https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq
• https://www.cancer.gov/types/ovarian/hp/ovarian-screening-pdq
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/ovarian-cancer-screening