Ovarian cancer is not a silent killer. The background noise, however, is almost deafening, and therein lies the problem. My take home message from this important paper is to distinguish carefully when taking a history between bloating (a symptom that comes and goes) and distension (which is persistent) especially if progressive and associated with anorexia, pain or urinary symptoms. Diligent examination and pelvic ultrasound scanning in such women should follow.