When Cecilia Lin, 40, first noticed that her lower abdomen was a little swollen and uncomfortable, she thought little of it. She had never had any health concerns and the discomfort was slight. But the seemingly minor symptoms persisted, and a month later, Lin (name changed for patient confidentiality reasons) decided it best to see a doctor.
As Lin's build was slight - she weighed barely 40kg - the distension of her abdomen was especially prominent when she lay on the examination table. Her doctor ordered an ultrasound scan, which showed a 20cm large mass on her ovary.
The mass comprised both solid and liquid parts, which was a worrying sign. Ovarian cysts are like liquid-filled balloons. Malignant tumours present with solid areas. Suspecting ovarian cancer, he referred her to a gynaecological oncologist.
Lin saw Dr Tam Kar-fai, a specialist in obstetrics and gynaecology at the Hong Kong Sanatorium and Hospital. During the examination, Tam found that the mass in Lin's abdomen was mobile - a good sign that it had probably not invaded other surrounding organs and structures.
He also ordered a blood test to check for an ovarian cancer marker called CA125 that shows up in 80 per cent of patients with the cancer. Lin had elevated CA125 levels. Although the test result was not diagnostic, it gave Tam enough reason to perform a laparotomy, which is a surgery to open up the abdomen to gain a definitive diagnosis and determine how far the cancer might have advanced.
Before surgery, Lin was given chest X-rays to ensure that her lungs were healthy. Some patients who exhibit bowel symptoms will also be checked for CEA markers presented by bowel tumours. Tam says it is common for bowel tumours to metastasise or spread to the ovaries.