Screening (for ovarian cancer)

There is little information concerning the nature of the precursor to a malignant ovarian tumour and there is, as yet, no proven role for a national screening programme for ovarian cancer.

The common epithelial cancers may develop from ovarian inclusion cysts. Unfortunately screening by ultrasonography does not reduce mortality from ovarian cancer.

Carcino-embryonic antigen is insufficiciently sensitive or specific to be used as a nationwide screening test (see linked term).

NICE have however stated how ultrasound and CA125 can be used in the management of possible ovarian cancer (1)

• awareness of symptoms and signs
  • refer the woman urgently if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids
    
    
  • carry out tests in primary care (see below) 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:
    • 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
      
      
  • consider carrying out tests in primary care (see below) if a woman reports unexplained weight loss, fatigue or changes in bowel habit
    
    
  • advise any woman who is not suspected of having ovarian cancer to return to her GP if her symptoms become more frequent and/or persistent
    
    
  • carry out appropriate tests for ovarian cancer (see below) 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
    
    
• primary care testing for possible ovarian cancer
  • measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer
  • if serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis
  • f the ultrasound suggests ovarian cancer, refer the woman urgently for further investigation
  • 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.

Reference:

• 1) NICE (March 2011). Ovarian cancer The recognition and initial management of ovarian cancer