Ovarian cancer affects almost 7,000 women a year but the symptoms are difficult to spot and many don't realise thay have this insidious disease until it's too late. Women's Editor Christen Peras reports.

THREE years ago, Nancy Martin was diagnosed with ovarian cancer. Like hundreds of women, the disease had been eating away at her for months without her realising.

"The first I knew there was something wrong was when I had abdominal pain and then my abdomen swelled up. It was so quick, it happened over a weekend and I was so worried, I went straight to my GP on the Monday," says the 52-year-old grandmother, who lives in Tursdale, near Durham.

She was sent for a scan later that week and diagnosed with ovarian cancer. A hysterectomy followed at the Queen Elizabeth Hospital in Gateshead and then a course of chemotherapy.

"It was a complete shock. I had heard about ovarian cancer, of course, but I didn't think it could ever happen to me, especially as we had no history of it in the family."

Nancy was lucky to discover her cancer in time. By the time it was diagnosed, it was already stage two.

"I was diagnosed in the May but I had been ill in March with what I thought was flu, although I felt really bloated as well. At the time, I didn't think anything of it because I had always been in good health. I was also 49 and at that age you're starting to approach the menopause and your body's changing. I assumed it was something to do with that.

"To be honest, I don't think there's anything else I could have done to detect it. I went to the doctor's as soon as I realised there was something wrong. I was just lucky it wasn't too late."

Nancy's case is not unusual, and most women miss the symptoms, which may seem minor at first. It is only as the tumour grows and spreads that they become more pronounced. It may press on neighbouring organs such as the bowel or bladder, causing constipation or frequent urination. There may also be a build-up of fluid in the abdominal cavity and around the lungs, which can cause shortness of breath.

"The symptoms are so vague - dyspepsia or abdominal distension - but not necessarily so severe you would go to your GP. It just gradually creeps up on you and it may take you six months before you start to notice your skirt's getting a bit tight. By the time it's spotted, it's often very advanced," says Keith Godfrey, clinical director at the Queen Elizabeth Hospital.

Ovarian cancer is less common than breast or lung cancer but almost 7,000 women in Britain are diagnosed with the disease each year, and more than 4,000 of them die.

Most of those affected by ovarian cancer are over 50 - American actress Madeleine Kahn was 57 when she died in 1997 - but it can also strike younger women. Pierce Brosnan's first wife, Cassandra, was 41 when she died of the disease.

The gynaecological oncology unit at the Queen Elizabeth Hospital, the region's main treatment centre, sees about 300 women a year from across the North-East.

A national screening programme already exists for breast and cervical cancer and, along with the James Cook University Hospital in Middlesbrough, the Queen Elizabeth is taking part in a Government-backed ovarian cancer screening study. More than 50,000 women across the UK have already been recruited to the study, which aims to determine whether screening saves lives.

Around 2,000 patients have been invited to the Gateshead hospital, for ultrasound scans to assess the ovaries and a blood test, which measures an antioxidant that is released into the blood by ovarian cancer cells.

Mr Godfrey says: "Survival rates for ovarian cancer are currently around 30 per cent at best and for the other 70 per cent, life expectancy is five years from diagnosis. Detection is the way forward. The earlier we can detect it, the better the chances of survival, and this study will help determine whether screening is effective."

When a woman is diagnosed with ovarian cancer, surgery is almost always the first treatment. At the moment, this involves removing the larger tumours and then allowing chemotherapy to shrink the smaller ones. Depending on how advanced the cancer is, this may require the removal of the ovaries, fallopian tubes and uterus.

"We have always done fairly massive surgery in the past but there is a sea change happening at the moment. If we think there is going to be large organ removal, we are trying to give patients chemo up front to see if we can reduce the tumours before we operate," says Mr Godfrey.

"If it is spotted early enough, treatment can be very effective. Unfortunately, because it is often so long before the patient realises there is something wrong, the cancer is usually quite advanced and survival rates are low."

Health charities are publicising the disease with the aim of reducing the number of deaths. This month is WellBeing's Ovarian Cancer Awareness Month while Ovacome is holding an awareness day on April 8. Nancy hopes women will take notice.

She says: "I'm still here and I'm still in remission - and for that I'm grateful - but there are lots of people who aren't. Most of the time, I can be positive but like most people who have cancer, I have my moments. When I heard about Barry Sheene dying last week, it really hit home. He was only 52 - the same age as me.

"When I first asked how long I had, the consultant told me I would see this Christmas and the next but, after that, he wasn't prepared to say. I haven't asked recently but I feel well at the moment. I just want to get to my five years and then hopefully, I'll be given the all-clear."

l For more information about ovarian cancer, call WellBeing's helpline on 020 7772 6400 or contact Ovacome on 020 7600 5141.