Summary of guidance relevant to general practice pubilshed in April 2011
GPs should perform a blood test to measure serum CA125 levels in women who present with symptoms that might indicate ovarian cancer.
NICE recommends that GPs perform CA125 testing in women who present with symptoms to help make an early diagnosis of ovarian cancer and to reduce any unnecessary referrals.
GPs should offer a serum CA125 test to any woman who reports any of the following symptoms persistently or frequently, especially if they are 50 or over:
- persistent abdominal distension
- pelvic or abdominal pain
- increased urinary urgency and/or frequency
- feeling full and/or loss of appetite.
These symptoms have a greater significance in women over the age of 50 and with a significant family history - that is, with two or more first-degree relatives diagnosed with ovarian or breast cancer at an early age.
The CA125 test should also be offered to women aged 50 and over if they have experienced symptoms suggestive of irritable bowel syndrome within the last 12 months.
GPs may consider offering the test if a woman reports unexplained weight loss, fatigue or changes in bowel habit.
If the serum CA125 level is 35 IU/ml or greater, the GP should arrange for the woman to have an ultrasound scan of the abdomen and pelvis.
If the ultrasound is suggestive of ovarian cancer, then the woman should be referred urgently (within 2 weeks) to a gynaecological cancer service.
If the woman has normal serum CA125 (less than 35 IU/ml), or a CA125 of 35 IU/ml or greater but a normal ultrasound, then the GP should assess her carefully for other clinical causes of her symptoms and investigate if appropriate.
GPs should not offer the CA125 test to any woman presenting with ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).
Instead she should be referred urgently (within 2 weeks) to a gynaecological cancer service.
Support tools to help you put this guidance into practice
We have produced a slide set , which you might find helpful when discussing this guideline in a practice meeting; a baseline assessment tool which can help to identify where you might need to change your clinical practice and audit support , including audit criteria and data collection sheets, to enable you to assess how well you are delivering the improvements NICE recommends.
You can also find a podcast about this guidance, on the NICE website, featuring Dr Craig Dobson, a GP and Senior Lecturer in Medical Education and General Practice at Hull/York Medical School and a member of the guideline development group for the Ovarian Cancer guideline.
This podcast focuses specifically the use of CA125 tests and how to manage patients who have negative results.
For full information about this guidance, and support from NICE for putting the guidance into practice, see www.nice.org.uk/guidance/CG122
27 April 2011