UK Guidelines for Diagnosing Ovarian Cancer

Draft guidelines have been developed for the National Health Service in England and Wales to aid earlier diagnosis and promote more effective management and support for women with ovarian cancer.  I make no excuse for writing again about early diagnosis of ovarian cancer, as most women have had symptoms for months before going to a physician, and there are often delays between first presentation and referral to a specialist.  Here are some of the principal guidelines for patient and family doctor:

Initiate tests if a woman (especially over the age of 50) reports having any of the following symptoms persistently or frequently - particularly if more than 12 times per month:

abdominal distension ('bloating')

difficulty eating and/or quickly feeling full (early satiety)

pelvic or abdominal pain

increased urinary frequency and/or a feeling of urgency

onset of symptoms that suggest irritable bowel syndrome (IBS) in a woman over 50, because IBS rarely presents for the first time in women of this age.

If there is reason for further testing, measure the serum CA-125 level; if it is greater than 35 IU/mL, schedule an ultrasound of the abdomen and pelvis.

If an ultrasound suggests ovarian cancer, perform a CT scan of the pelvis, abdomen and thorax to establish the extent of disease.  An MRI is not necessary.

If the CA-125 is normal, or there is a raised CA-125 but a normal ultrasound, the patient should return to her family doctor for re-assessment if her symptoms persist.

It’s also important to know that (at least, in UK), one third of women diagnosed with ovarian cancer did not have their emotional and practical support needs met.  All women with newly diagnosed ovarian cancer must therefore be offered information about their disease, including psychosocial and psychosexual issues, that’s available at the time they want it, contains the amount of detail that they want (and can deal with), and includes written information if possible.

Although these guidelines are in a draft form open for consultation, they offer an approach to diagnosis that’s fully compatible with expert thinking in the USA. All women and family practitioners should be familiar with their general principles.