Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Awareness of symptoms and signs

  • Carry out tests in primary care (see section 1.1.2) 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[2]:

    • persistent abdominal distension (women often refer to this as 'bloating')

    • feeling full (early satiety) and/or loss of appetite

    • pelvic or abdominal pain

    • increased urinary urgency and/or frequency.

  • Carry out appropriate tests for ovarian cancer (see section 1.1.2) in any woman of 50 or over who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS)[3], because IBS rarely presents for the first time in women of this age.

Asking the right question – first tests

  • Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer (see section 1.1.1).

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

  • 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.

Malignancy indices

  • Calculate a risk of malignancy index I (RMI I) score[4] (after performing an ultrasound; see recommendation 1.2.3.1) and refer all women with an RMI I score of 250 or greater to a specialist multidisciplinary team.

Tissue diagnosis

  • 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.

The role of systematic retroperitoneal lymphadenectomy

  • Do not include systematic retroperitoneal lymphadenectomy (block dissection of lymph nodes from the pelvic side walls to the level of the renal veins) as part of standard surgical treatment in women with suspected ovarian cancer whose disease appears to be confined to the ovaries (that is, who appear to have stage I disease).

Adjuvant systemic chemotherapy for stage I disease

  • Do not offer adjuvant chemotherapy to women who have had optimal surgical staging[5] and have low-risk stage I disease (grade 1 or 2, stage Ia or 1b).

Support needs of women with newly diagnosed ovarian cancer

  • Offer all women with newly diagnosed ovarian cancer information about their disease, including psychosocial and psychosexual issues, that:

    • is available at the time they want it

    • includes the amount of detail that they want and are able to deal with

    • is in a suitable format, including written information.



[2] See also Referral guidelines for suspected cancer (NICE clinical guideline 27) for recommendations about the support and information needs of people with suspected cancer.

[3] See Irritable bowel syndrome in adults (NICE clinical guideline 61).

[4] See appendix D for details of how to calculate an RMI I score.

[5] Optimal surgical staging constitutes: midline laparotomy to allow thorough assessment of the abdomen and pelvis; a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy; biopsies of any peritoneal deposits; random biopsies of the pelvic and abdominal peritoneum; and retroperitoneal lymph node assessment [Winter Roach BA, Kitchener HC, Dickinson HO (2009) Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database of Systematic Reviews issue 3: CD004706].

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