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Table 3 Summary of tests recommended for the assessment of symptoms and/or signs of ovarian cancer

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

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
  1. Guidelines are grouped into categories on the bases of the number and order of tests advocated