Linking To And Excerpting From NICE’s “Ovarian cancer: recognition and initial management”

Posted on November 3, 2024 by Tom Wade MD

Note: The USPTF does not recommend screening asymptomatic women at average risk for ovarian cancer.

But if a patient is symptomatic she should be evaluated for ovarian cancer*:

*Ovarian cancer: recognition and initial manafgement
Clinical guideline [CG122]Published: 27 April 2011 Last updated: 02 October 2023

Carry out tests in primary care (see the section on asking the right question – first tests) if a woman (especially if 50 or over) reports having any of the following symptoms on a persistent or frequent basis – particularly more than 12 times per month:

 

Today, I review, link to, and excerpt from Ovarian cancer: recognition and initial management*from The National Institute For Health and Care Excellence (NICE).

*Ovarian cancer: recognition and initial manafgement
Clinical guideline [CG122]Published: 27 April 2011 Last updated: 02 October 2023

All that follows is from the above resource.

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE’s information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Detection in primary care

Recommendations in this section have been incorporated into the NICE guideline on suspected cancer.

1.1.1 Awareness of symptoms and signs

1.1.1.1

Refer the woman using a suspected cancer pathway referral if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).

1.1.1.2

Carry out tests in primary care (see the section on asking the right question – first tests) if a woman (especially if 50 or over) reports having any of the following symptoms on a persistent or frequent basis – particularly more than 12 times per month:

1.1.1.4

Advise any woman who is not suspected of having ovarian cancer to return to her GP if her symptoms become more frequent and/or persistent.

1.1.2 Asking the right question – first tests

1.1.2.2

If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.

1.1.2.4

For any woman who has normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound:

  • assess her carefully for other clinical causes of her symptoms and investigate if appropriate
  • if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent.

1.2 Establishing the diagnosis in secondary care

1.2.1 Tumour markers: which to use?

1.2.1.1

Measure serum CA125 in secondary care in all women with suspected ovarian cancer, if this has not already been done in primary care.

1.2.1.2

In women under 40 with suspected ovarian cancer, measure levels of alpha fetoprotein (AFP) and beta human chorionic gonadotrophin (beta-hCG) as well as serum CA125, to identify women who may not have epithelial ovarian cancer.

1.2.2 Malignancy indices

1.2.3 Imaging in the diagnostic pathway: which procedures?

1.2.3.1

Perform an ultrasound of the abdomen and pelvis as the first imaging test in secondary care for women with suspected ovarian cancer, if this has not already been done in primary care.

1.2.3.2

If the ultrasound, serum CA125 and clinical status suggest ovarian cancer, perform a CT scan of the pelvis and abdomen to establish the extent of disease. Include the thorax if clinically indicated.

1.2.3.3

Do not use MRI routinely for assessing women with suspected ovarian cancer.

1.2.4 Tissue diagnosis

Requirement for tissue diagnosis

1.2.4.1

If offering cytotoxic chemotherapy to women with suspected advanced ovarian cancer, first obtain a confirmed tissue diagnosis by histology (or by cytology if histology is not appropriate) in all but exceptional cases.

1.2.4.2

Offer cytotoxic chemotherapy for suspected advanced ovarian cancer without a tissue diagnosis (histology or cytology) only:

  • in exceptional cases, after discussion at the multidisciplinary team and
  • after discussing with the woman the possible benefits and risks of starting chemotherapy without a tissue diagnosis.

Methods of tissue diagnosis other than laparotomy

1.2.4.3

If surgery has not been performed, use histology rather than cytology to obtain a tissue diagnosis. To obtain tissue for histology:

  • use percutaneous image-guided biopsy if this is feasible
  • consider laparoscopic biopsy if percutaneous image-guided biopsy is not feasible or has not produced an adequate sample.

    Use cytology if histology is not appropriate.

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