I am told that ovarian cancer is a silent killer. I am rather plump – how does anyone know that tucked away behind my spare tyre there is not a tumour lurking in my ovaries? I am 55 and have two children, the first of which was born when I was 26.

Ovarian cancer was once thought of as being as deadly and insidious as a dose of radioactive polonium. However, it seems that the pessimism over the outcome of this disease is lifting. Although five-year survival rates for women with advanced cancer are just 20 to 30 per cent, those whose conditions are diagnosed when the disease is confined to the ovary now have a 70-90 per cent chance of being cured.

The American Cancer Society recently published a suggested method to increase early detection and hence survival rates. Dr Barbara Goff and her team at the department of gynaecology at the Washington School of Medicine, Seattle, found that careful analysis of the patient leads to a better understanding of which of the common symptoms were most significant. The team is hopeful that this will help to reduce ovarian cancer’s reputation as a silent killer.

Before steady, painstaking detective work had uncovered the significance of the apparently innocuous cup of tea that Alexander Litvinenko sipped in the bar of the Millennium Hotel in Grosvenor Square, London, it seemed like any other cuppa. Later, of course, its true importance was realised. Similarly, many of the early symptoms of ovarian cancer may seem as commonplace and innocent as a cup of tea.

Dr Goff has studied the symptoms and used modern medical detective work – in this case logistic regression analysis – in a large group of women in a screening programme who had been referred for pelvic/abdomi-nal ultrasound. She assessed the relative importance of their range of symptoms to determine which needed further examination and an explanation.

In criminal detection, as in medicine, the mysteries of a case are usually solved beyond question by scientific analysis. Modern medicine is dependent on the skills of pathologists and radiologists, together with their teams of highly trained medical scientists. Just as policemen need to take detailed statements from witnesses, so doctors need to persuade patients to talk about every detail of their symptoms.

However trivial the doctor’s questions may seem, the answers may provide the solution to the diagnostic problem. The doctor, just like a detective, has to probe the patient’s background, family history and lifestyle before they can assess the case.

Only by exploring background and symptomatology is it possible to know who needs investigation. Modern pathological and radiological tests show that either the symptom is troublesome but benign, or they provide clues to warn of the presence of a villainous cancer – hopefully before it has become embedded and spread.

Cancers are sometimes perceived as being silent killers but often they can be uncovered by the repetitive nature of the patient’s symptoms. It seems from Dr Goff’s research that the (usually benign) symptoms that can warn of cancer of the ovary have varying significance. There may also be a chronological pattern to the symptoms that suggests the possibility of a tumour.

Doctors need to be alert to the hints that can lead to early diagnosis and a successful outcome. Even if caution leads them to follow many false trails, these should never be considered a waste of time or money. They are a necessary precaution that may lead to fewer deaths.

Dr Goff showed that the most significant symptoms associated with ovarian cancer were pelvic/abdominal pain, urinary urgency/frequency (having to rush to the lavatory rapidly and frequently), increased abdominal girth, bloating, loss of appetite and feeling full.

These symptoms were particularly important when they were present and increasing for up to a year and occurred more than 12 days in one month. The most important symptoms were pelvic/abdominal pain, the relatively rapid increase in abdominal size and bloating, and difficulties in eating because the patient feels full.