This presentation covers the difficulties facing primary care when trying to diagnose suspected ovarian cancer. We cover the challenging symptoms and signs, the caveats of the CA125 blood test, the importance of the physical examination and the different routes into the cancer pathway including GP direct access to imaging. Ovarian cancer diagnosis in the early stages is rare and there is no screening for this tumour type. Symptoms often develop with advanced disease and hence urgent referral on a cancer pathway once suspected is essential to offer radical treatment. We go through case examples describing when patients are referred covering learning from common themes.