How to assess ovarian cancer risk in women with abdominal symptoms, and when to

Ovarian cancer risk should be assessed in women presenting with abdominal symptoms by first performing an abdominal and pelvic examination. If there is ascites or a pelvic or abdominal mass (which is not obviously uterine fibroids), refer the woman urgently to a gynaecological cancer service for further investigation, to be seen within 2 weeks ¹.

If the examination is normal, measure serum CA125 concentration. If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis. If the ultrasound suggests ovarian cancer, refer the woman urgently for further investigation ¹.

In women aged 50 or over with symptoms within the last 12 months that suggest IBS, carry out appropriate tests for ovarian cancer, including measuring serum CA125 in primary care ¹.

Women should be referred using a suspected cancer pathway referral if physical examination identifies ascites and/or a pelvic or abdominal mass (not obviously uterine fibroids) ¹.