Investigation of Possible Ovarian Cancer / CA125 guidance

If a suspicious pelvic mass, or ascites is felt on examination, arrange a CA125 and USS then refer to Gynae 2 week wait pathway with the results as per


 When to test CA125 in Primary Care

If a woman (especially if 50 or over) reports having any of the following symptoms on a persistent or frequent basis:

o    persistent abdominal distension/bloating

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

o    pelvic or abdominal pain

o    increased urinary urgency and/or frequency.

o    Consider a ca125 if a woman reports unexplained weight loss, fatigue or changes in bowel habit.

o    Consider a ca125 in any woman of 50 or over who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS), because IBS rarely presents for the first time in women of this age

If CA125 is normal

  • assess other causes for symptoms LINK below,and
  • encourage her to come back if symptoms worsen or persist.

If CA125 is raised(35 u/ml or greater)

  • arrange urgent pelvic USS.

 If ultrasound scan suggests cancer → refer to Gynae 2 week wait

 If normal USS, then

  • assess for other causes* of raised CA125 LINK below
  • repeat CA125 after 8 weeks

 If 2nd CA125 is normal, then encourage her to come back if symptoms worsen or persist.

If 2nd CA125 is elevated but not significantly rising repeat the Pelvic USS 8-12 weeks after the initial USS.

If 2nd CA125 is significantly rising arrange an urgent CT Abdomen/Pelvis.


A raised CA125 in a younger woman is less likely to be related to a diagnosis of ovarian cancer whereas a level of >1000 in a postmenopausal woman is highly significant and points to some sort of malignancy.…

 * For other causes of raised CA125 please click here