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Ovarian cancer

Ovarian cancer: symptoms to recognise and the GP pathway in Australia

By Dr HB Lo, FACRRM

Reviewed 8 August 2026
9 min read

Ovarian cancer kills approximately 1,000 Australians annually; over 70% are diagnosed at advanced stage. No effective population screening exists — CA-125 and ultrasound did not reduce mortality in the UKCTOCS trial.

Recognise the symptom cluster: abdominal bloating, early satiety, pelvic pain, or urinary frequency more than 12 times per month in a woman aged 50 or older. Combine CA-125 and transvaginal ultrasound as the Risk of Malignancy Index (RMI) — an RMI ≥250 warrants gynaecological oncology review within two weeks.

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Ovarian cancer is Australia’s most lethal gynaecological malignancy. AIHW 2024 data records approximately 1,815 new diagnoses and 1,030 deaths per year, with a five-year survival rate of 46% — a figure that has improved only slowly,



because more than 70% of cases present at FIGO stage III or IV, when cure is rare. No mass-screening programme exists. The GP remains the single most important clinician positioned to shorten the diagnostic delay.

This article covers how ovarian cancer presents, how to investigate a pelvic mass, the Risk of Malignancy Index, family history assessment, and the Australian referral pathway.

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Why ovarian cancer is diagnosed late

The dominant histological subtype — high-grade serous carcinoma (HGSC), accounting for approximately 75% of cases — spreads rapidly along peritoneal surfaces before any single symptom becomes specific enough to prompt investigation. Research since 2007 (Crum, Clin Med Res) has established that HGSC originates from the fallopian tube fimbria via a precursor lesion (serous tubal intra-epithelial carcinoma, STIC), not from the ovarian surface epithelium as previo

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