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Last updated: 30 March, 2020 15:59pm

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Investigation of Possible Ovarian Cancer – Information for GPs

Commissioning position

Ovarian cancer should be considered in any woman (especially over 50) who has the following symptoms persistently and frequently (more than 12 times a month):

  • Abdominal distension (bloating)
  • Feeling full (early satiety) and / or loss of appetite
  • Pelvic or abdominal pain
  • Increased urinary urgency and/or frequency
  • New symptoms of IBS

Also consider in women with:

  • Unexplained weight loss
  • Fatigue
  • Change in bowel habit

Red flag symptoms

  • Ascites or pelvic/abdominal mass (not obviously fibroids) on examination – refer 2WW
  • USS suggestion of ovarian cancer – refer 2WW

General points - Family history of ovarian cancer

Ask about family history breast cancer. Hereditary risks of Ovarian cancer


  • Measure serum CA125 and wait for results before ordering ultrasound
  • If CA125 > 35IU/ml – arrange urgent USS of abdomen and pelvis
  • If CA125 <35IU/ml – consider other causes of symptoms and investigations. Patient to return if symptoms not settling
  • Other causes for raised CA125. Causes of raised CA125
  • If USS abnormal – refer 2WW

Investigations prior to referral

CA125 and USS if indicated

Information to include in referral letter

  • Description of symptoms and duration
  • Any family history of ovarian or breast cancer
  • Current contraception/hormone therapy
  • Abdominal, speculum and pelvic examination
  • Smear history
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical / surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient information

Ovarian Cancer Screening – signs, symptoms and treatment, here.

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