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Table 2 Physical examinations recommended and ovarian cancer signs noted within guidance documents

From: Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines

Document Type of examination specified Signs
Continental Europe
 Epithelial ovarian carcinoma (Neth) Not specified - Pelvic mass / abdominal mass
- Ascites
- Pleural effusion
- Increased uterine / vaginal prolapse
- Enlarged supraclavicular lymph nodes
 Guideline on diagnostics, therapy and follow-up of malignant ovarian tumours (Ger) Abdominal and pelvic / gynaecological examination (including digital and speculum) - Ovarian mass
United Kingdom and the Republic of Ireland
 Epithelial Ovarian / Fallopian Tube / Primary Peritoneal Cancer Guidelines: recommendations for practice (UK) Examination - Pelvic or abdominal mass
 Suspected cancer: recognition and referral (Eng) Physical examination - Ascites
- Pelvic / abdominal mass (not obviously uterine fibroids)
 Ovarian cancer GP referral for symptomatic women (Ire) Clinical examination (include a bimanual-pelvic examination) - Unexplained ascites
- Pelvic mass
- Palpable ovaries in postmenopausal women
 Scottish referral guidelines for suspected cancer (Scot)a Abdominal palpation - Ascites
- Pelvic or abdominal mass (not obviously uterine fibroids, gastrointestinal or urological in origin)
 Management of epithelial ovarian cancer (Scot) Not specified - Not specified
Scandinavia
 Integrated ovarian cancer patient pathway (Den) Gynaecological examination (including palpation and speculum) - Ascites
- Pelvic mass
 Ovarian cancer patient pathway (Nor) Not specified - Not specified
 Standardised ovarian cancer care pathway (Swed)b Palpation of superficial lymph nodes, abdominal palpation, rectal examination and auscultation of the heart and lungs - Pleural effusion (unexplained)
- Ascites
Australasia
 Assessment of symptoms that may be ovarian cancer: a guide for general practitioners (Aus) Abdominal palpation, pelvic assessment, vaginal and rectal examination - Firm resistance on abdominal palpation
- Unexplained fullness
-Fullness + shifting dullness on percussion
- Hard irregular mass in the pouch of Douglass
- Adnexal mass
 Appropriate referral of women with suspected ovarian cancer (Aus) Not specified - Not specified
 Optimal care pathway for women with ovarian cancer (Aus) General and pelvic examination - Not specified
 Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparity (NZ) Abdominal palpation and pelvic examination - Not specified
North America
 Ovarian cancer: including fallopian tube cancer and primary peritoneal cancer (USA) Abdominal and pelvic examination - Suspicious palpable pelvic or abdominal mass
- Ascites or abdominal distension
 The role of the obstetrician-gynaecologist in the early detection of epithelial ovarian cancer in women at average risk (USA) Not specified - Not specified
 Ovarian cancer diagnosis pathway map (Ont, Can) Directed physical examination. Pelvic examination including speculum and bimanual examinations and examination of the external genitalia - Suspicious palpable pelvic or abdominal mass
- Ascites
 Genital tract cancers in females: ovarian, fallopian tube, and primary peritoneal cancers (BC, Can) A physical examination of the abdomen and pelvis including a pelvi-rectal examination - Abdominal mass
  1. aAs recorded on associated Microsite and Short guidance document. The full guideline covers all gynaecological cancers with examinations and findings listed together. Microsite and Short guideline lists examinations and signs by cancer site
  2. bBoth a full clinical practice guideline covering initial assessment, definitive diagnosis and treatment, and a short version focusing on initial assessment and investigation in primary care, are available. Guidance on initial assessment differed slightly between the two documents. The presented data was extracted from the short guide