Strategy | Guideline | When is testing advocated? | Initial tests |
---|---|---|---|
Single test | Guideline on diagnostics, therapy and follow-up of malignant ovarian tumours (Ger) | Signs or symptoms of ovarian cancer (OC) | Transvaginal US Note: CT, MRI, PET CT may be used in specific cases |
Dual testing | Scottish referral guidelines for suspected cancer (Scot) | Symptoms of OC Note: Ascites- refer urgently rather than test | CA125 + pelvic US |
Management of epithelial ovarian cancer (Scot) | Symptoms of OC | CA125 + pelvic US | |
Assessment of symptoms that may be ovarian cancer: a guide for general practitioners (Aus) | Mass identified clinically Note: No mass identified clinically- refer appropriately | CA125 + transvaginal US Or CA125 + Abdominal US Or CA125 + CT | |
Appropriate referral of women with suspected ovarian cancer (Aus) | Suspicious findings on clinical examination | CA125 + transvaginal US +/− calculation of Risk of Malignancy Index (RMI) | |
Sequential testing | Suspected cancer: recognition and referral (Eng) | OC symptoms Note: Ascites or suspicious mass- refer urgently rather than test | First line: CA125 Second line: Abdominopelvic US (if CA125 is abnormal) |
Epithelial ovarian / fallopian tube / primary peritoneal cancer guidelines: recommendations for practice (UK) | OC symptoms Note: Pelvic or abdominal mass- refer urgently rather than test | First line: CA125 Second line: Abdominopelvic US (if CA125 is abnormal) | |
Ovarian cancer GP referral for symptomatic women (Ire) | History suspicious of OC but examination normal Note: Suspicious pelvis mass or ascites- refer urgently rather than test | First line: CA125 Second line: US of pelvis (If CA125 35–200 u/ml) Note: If CA125 > 200 u/ml refer without US | |
Ovarian cancer diagnosis pathway map (Ont, Can) | Suspicion of OC Note: Tests may be performed prior to specialist referral but are not a requirement for referral. Can refer prior to testing | First line: Transvaginal US and / or other imaging Second line: CA125, FBC, Renal Function + RMI (If indicated: CEA, CA19–9, other tumour markers e.g. AFP, LDH, HCG) | |
Multiple testing options | Optimal care pathway for women with ovarian cancer (Aus) | Symptoms of OC | Pelvic US + Routine blood tests + CA125 + Algorithms such as RMI, ADNEX +/− CT scan |
Genital tract cancers in females: ovarian, fallopian tube, and primary peritoneal cancers (BC, Can) | Suspicion of OC Note: Imaging not essential for referral | Transvaginal or abdominal US Blood tests: CA125, CA19–9, CA15–3, CEA < 40 yrs old: AFP, HCG, LDH | |
Ovarian cancer Including fallopian tube cancer and primary peritoneal cancer (USA) | Suspicion of OC Note: Provides some advice on when particular tests are indicated. Appears to include both initial and pre-surgical tests | US and/or abdominal/pelvic CT/MRI (as indicated) Chest CT or chest x-ray (as indicated) Complete blood count, chemistry profile and LFT CA125 or other tumour markers (as indicated: inhibin, β-hCG, AFP, LDH, CEA, CA19–9) Nutritional status GI evaluation (as indicated) | |
No testing prior to referral | Integrated ovarian cancer patient pathway (Den) | At point of specialist referral | Note CA125 requested in primary care at time of referral so as to be available to the specialist. Not acted upon in primary care |
Ovarian cancer patient pathway (Nor) | Post specialist referral | Post referral | |
Standardised ovarian cancer care pathway (Swed) | At point of specialist referral | Note CA125 requested in primary care at time of referral so as to be available to the specialist. Not acted upon in primary care | |
Unclear or no recommendations on testing given | Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparity (NZ) | No recommendations | No recommendations |
The role of the obstetrician-gynaecologist in the early detection of epithelial ovarian cancer in women at average risk (USA) | No recommendations | No recommendations | |
Epithelial ovarian carcinoma (Netherlands) | Suspicion of OC. Not clear which tests should be used and when they should be used for initial investigation | Blood tests discussed: routine blood tests, CA125 +/− CEA |