After a long day of remote work, Sally-Anne Hawkins soaked in a hot bath, finally feeling some relief from months of abdominal pain.

Her doctor had given her medication for an overactive bladder, but it did little to alleviate the discomfort. Sally-Anne also dealt with persistent bloating and frequent urges to use the bathroom.

The bath was a comfort she could rely on to ease the discomfort. Thankfully, the pain diminished enough for her to consider getting out and returning to her tasks.

However, just as she stood up and put one foot on the bathmat, a shocking pain in the left side of her pelvis came out of nowhere.

‘I’ve never experienced pain like it,’ says Sally-Anne, 38, an account manager for a printing company residing in Hampshire with her husband Andy, 56, who works as a warehouse driver.

‘It was so severe I thought I might go into shock; on a scale of one-to-ten it was without doubt an 11.’

Reaching for her phone, Sally-Anne called Andy to ask him to return home immediately. Fortunately, his job was close by, and he arrived in about ten minutes—the same time it took her to carefully make her way downstairs to the entrance.

When Andy got there, she managed to stand up and unlock the door before collapsing again in agony. ‘You need to call an ambulance,’ Sally-Anne urged him, shortly before being sick.

At the hospital doctors thought she had a burst appendix, or perhaps a twisted ovary – but a blood test and scans identified the cause: stage 1 ovarian cancer.

Doctors said the action of twisting her body to get out of the bath pushed the tumour on her left ovary enough to make it rupture.

While it might not seem so, Sally-Anne is one of the lucky ones – the shocking pain of a ruptured tumour forced her to go to hospital for the tests that led to the cancer being diagnosed early.

Yet early diagnosis is far from the norm for ovarian cancer.

‘Of the 7,500 women diagnosed with ovarian cancer every year, around 70 per cent are diagnosed at an advanced stage (i.e. stage three or four), when the cancer has spread into the abdomen, the lymph nodes or to more distant organs such as the lungs,’ says Dr Louise Wan, a consultant gynaecologist at Liverpool Women’s Hospital.

‘Sadly, this means around 3,900 women die of it every year. Cases are also projected to rise by approximately 5 per cent by 2040 due to our ageing population.’

Older age and having a family history of ovarian or breast cancer raises your risk – as does having inherited certain genes.

For example, faulty BRCA 1 and 2 genes are linked to an increased risk of developing ovarian (as well as breast) cancer.

‘The problem is that symptoms can be non-specific: bloating, abdominal discomfort, a change in appetite – these are all things we can feel once in a while without them being serious,’ adds Dr Wan, who is also specialty lead for research in gynaecological cancers for The British Gynaecological Cancer Society.

‘They can also be mistaken for something else such as IBS or cystitis. It can make it challenging to identify, for both women and doctors alike.’

This rings true for Sally-Anne. ‘In April last year my tummy felt heavy and bloated, like I’d overeaten,’ she recalls. ‘Except it didn’t get better after a night’s sleep or going to the loo. I figured I’d put on weight and needed to exercise more – but upping the amount I walked and using gym equipment at home made no difference.

‘A month later I couldn’t button up my jeans and people at work were asking if I was pregnant.’

Sally-Anne’s GP told her she had a gastric bug and just needed to rest. ‘I told him it didn’t seem quite right – I wasn’t being sick. But he was the doctor, not me, so I went home and got on with things,’ she says.

However, a month later, other symptoms appeared: as well as the bloating (she was now living in loose dresses and oversized tops), she had intermittent pain at the top of her pelvis and needed to wee more often.

‘I’d go to the loo, finish, then need to go again,’ says Sally-Anne. She contacted her GP who diagnosed her over the phone with an overactive bladder.

‘I was prescribed a week’s worth of the medication solifenacin to relax the muscles in my bladder,’ says Sally-Anne. ‘I was totally unaware my symptoms were classic for ovarian cancer.’

It’s a worryingly familiar scenario. ‘Awareness of key symptoms of ovarian cancer is alarmingly low,’ says Dr Wan.

Yet it’s knowledge that can save lives. ‘Diagnose the disease before it’s spread outside the ovaries and there is a 95 per cent chance of survival, that’s double the average ovarian cancer survival rate.

‘With no national screening programme – smear tests check for cervical cancer, not ovarian – women must raise any red-flag symptoms with their GP and push for investigations,’ says Dr Wan.

A blood test that detects a protein – CA 125 – often made by ovarian cancer cells can indicate a high risk. ‘But fibroids and endometriosis can also raise CA 125 levels – so if levels are high you’d be referred for an ultrasound, further blood tests, a CT scan or a biopsy to confirm it’s cancer,’ adds Dr Wan.

However, Sally-Anne wasn’t offered these checks until she was doubled over in agony in A&E (it is extremely rare for a tumour to rupture, as hers had).

As she recalls: ‘When I arrived, the nurse in charge took one look at me and rushed me through. I was given morphine for the pain and underwent the CA 125 blood test, as well as a CT scan of my tummy.’

Normal CA 125 levels are about 35 – Sally-Anne’s was 5,555. In fact, the tumour rupturing had led to sepsis, a life-threatening reaction to infection – which had contributed to her raised CA 125 levels.

It took nearly a week for Sally to be told they thought she had cancer on her left ovary. She underwent keyhole surgery and the ovary was removed – a biopsy confirmed she had stage 1 ovarian cancer. Sally-Anne was given the option of being monitored, or having a hysterectomy – removing her remaining ovary as well as her womb to reduce the risk of it recurring.

‘I went for a hysterectomy,’ she says. ‘I have never wanted children – plus the regular scans, blood tests and oncology appointments were becoming too stressful.’

The surgery, in May, revealed another tumour in her right ovary.

She now has a scan every six months.

‘The hysterectomy has pushed me into menopause, which triggers severe symptoms such as hot flushes and difficulty sleeping – but I’m on HRT to manage these.’

Sally-Anne is now getting back to some sort of ‘normal’. She’s free from pain, planning holidays, enjoying her job and spending time with her husband, nephews and niece.

‘I know I’ve been lucky – it could have so easily gone the other way. Being aware of the symptoms of ovarian cancer is something I cannot stress enough.’

• Ovarian Cancer Action’s symptom checker can be found at ovarian.org.uk