STEP 2: Presentation, initial investigations and referral

Signs and symptoms

Symptoms for ovarian cancer are vague and non-specific, but persistent symptoms should be investigated, particularly in older women or those with family history. Symptoms may include:

  • abdominal bloating
  • increased abdominal girth
  • abdominal and/or pelvic pain
  • indigestion
  • lack of appetite
  • feeling full after only a small amount of food
  • unexplained weight gain or weight loss
  • change in bowel habits
  • fatigue
  • urinary frequency or incontinence
  • pressure in the abdomen.

Initial investigations include:

  • a general and pelvic examination, including rectal examination
  • pelvic ultrasound (preferably transvaginal)
  • CT scan if appropriate
  • routine blood and tumour marker tests (CA125, CEA and, in younger women, HCG, AFP, LDH).

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



Symptoms that persist for more than 4 weeks should be investigated.

Symptoms persisting for more than 1 week after initial treatment initiated by the GP should be further investigated within 2 weeks.

If ovarian cancer is suspected, initial investigations by the GP should be completed and results reviewed by the GP with the patient within 2 weeks of the patient initially presenting with symptoms.

The specialist appointment should occur within 2 weeks of a suspected or confirmed diagnosis.