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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 http://www.royalcornwall.nhs.uk/services/cancer-services

 

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 basis:

  • abdominal distension/bloating
  • feeling full (early satiety) and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency.
  • Consider a ca125 if a woman reports unexplained weight loss, fatigue or changes in bowel habit.
  • 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.

Urgent ultrasound scans (within 4 weeks) are available for women with a raised CA 125 of 35 or greater by referring to Korus/Peninsula. 

If there are obvious symptoms of ovarian cancer with a very high CA 125 (high hundreds or thousands) not likely to be caused by another cause, and you feel that earlier investigation is needed, consider making a 2ww suspected ovarian cancer referral without a USS. 

 

 *Other causes of raised CA125:

  • Ovulation
  • Pregnancy
  • Endometriosis
  • Benign ovarian cysts
  • Fibroids
  • Autoimmune diseases
  • Non ovarian malignant conditions

 

NOTE: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.

 

References:

https://www.nice.org.uk/guidance/cg122/chapter/1-Guidance#detection-in-primary-care

http://pathways.nice.org.uk/pathways/ovarian-cancer/ovarian-cancer-detection-in-primary-care#content=view-quality-statement%3Aquality-statements-advice

Author: Dr S Burns, GP

Contributors: Lisa Verity Consultant Gynaecologist RCHT, Sophia Julian Consultant Gynae Oncology Consultant RCHT

Version:1.2

Date: March 2020             Review Date: March 2021