Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Awareness of symptoms and signs

Asking the right question – first tests

  • Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer (see section on awareness of symptoms and signs).

  • 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 (after performing an ultrasound; see recommendation and refer all women with an RMI I score of 250 or greater to a specialist multidisciplinary team.

    See the appendix for details of how to calculate an RMI I score.

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 and have low-risk stage I disease (grade 1 or 2, stage Ia or 1b).

    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 et al. [2009]).

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.

  • National Institute for Health and Care Excellence (NICE)