Ovarian cancer

Quality statement

Women with a risk of malignancy index (RMI I) score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.

Quality measure

Structure: Evidence of local arrangements to ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.

Process: Proportion of women with an RMI I score of 250 or greater referred to a specialist gynaecological cancer multidisciplinary team.

Numerator – the number of women in the denominator referred to a specialist gynaecological cancer multidisciplinary team.

Denominator – the number of women with an RMI I score of 250 or greater.

What the quality statement means for each audience

Service providers ensure systems are in place for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.

Healthcare professionals ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.

Commissioners ensure they commission services for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.

Women with suspected ovarian cancer have their 'risk of malignancy' or RMI I score calculated (using their CA125 and ultrasound results and whether they have had the menopause) to help find out if ovarian cancer is likely. Women with a high RMI I score (250 or more) are referred to a team of healthcare professionals who are experienced in treating women with ovarian cancer, called a specialist gynaecological cancer multidisciplinary team.

Source guidance

NICE clinical guideline 122 recommendation 1.2.2.1 (key priority for implementation).

Data source

Structure: Local data collection.

Process: Local data collection. Also contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): secondary care, criteria 3.

Definitions

NICE clinical guideline 122 defines how RMI I should be calculated in appendix D. RMI I combines three pre-surgical features: CA125, menopausal status (M) and ultrasound score (U). The RMI is a product of the ultrasound scan score, the menopausal status and the CA125 level (IU/ml).

RMI = U x M x CA125

The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2–5).

The menopausal status is scored as 1 = pre-menopausal and 3 = post-menopausal. The classification of 'post-menopausal' is a woman who has had no period for more than 1 year or a woman over 50 who has had a hysterectomy.

CA125 is measured in IU/ml and can vary between 0 and hundreds or even thousands of units.

Specialist core members of a multidisciplinary team are described in the National Cancer Peer Review Programme's Manual for Cancer Services in gynaecology measure 11-2E-101.