Further investigations

Dr McGoldrick continues to reflect on the information provided by Karen and discusses the tests he would like to conduct.

• The NICE NG12 guidance currently states that an ultrasound and a CA125 test should be completed in a certain chronological order (measure serum CA125, then arrange an ultrasound scan); however, in practice these are often organised at the same time.
• Additionally, the latest NICE NG12 guidance recommends making an urgent referral to a gynaecological cancer service if the ultrasound suggests ovarian cancer.
• If a non-site specific clinic is available, this may be the optimal referral route.
• If a patient is referred to secondary care for suspected colorectal cancer and test results are negative, ovarian cancer should be considered.
• Best practice is always to advise patients to return to their GP should symptoms persist, change, or worsen.
• It is important that practices have systems in place to ensure patients attend for suspected cancer investigations and results are dealt with. Find out more about safety netting measures here

Improved detection

Dr Rebecca Leon discusses improved detection with Prof. Gordon Jayson.

The use of the CA125 in ovarian cancer diagnosis

Prof. Gordon Jayson and Dr Rebecca Leon discuss the reliability of CA125 in diagnosing ovarian cancer.

Please note: Prof. Gordon Jayson recommends that CA125 is not a good screening tool for the asymptomatic patient and should not be used in screening the general population.

*Arranging a transvaginal ultrasound is the gold standard, but if this is not possible, organise an ultrasound of the abdomen and pelvis as per NICE guidelines.

Summary of Karen’s condition: Karen’s CA125 showed a raised level of 90 and an ultrasound showing stage 3 ovarian cancer. Karen was referred to a specialist to discuss treatment options. It is important that the GP safety nets and provides
clear guidance if a patient’s condition remains the same, progresses or persists.

Additional resources

Link: Ovarian cancer: recognition and initial management, NICE (2011)
Link: Suspected cancer: recognition and referral, NICE (2020)
Link: Ovarian Cancer Action guide for primary care, Ovarian Cancer Action (2019)
Link: Diagnostic tests for ovarian cancer: A guide for primary care, Target Ovarian Cancer (2019)