According to the NICE ovarian cancer clinical guideline, if a woman - especially if aged 50 years or older - presents with symptoms of ovarian cancer persistently or frequently – particularly more than 12 times per month, you should:
Conduct a physical examination in primary care
In a physical examination you are looking for ascites and/or a pelvic or an abdominal mass that is not obviously uterine fibroids.
If ascites or a pelvic abdominal mass is found, according to the NICE clinical guideline, a woman should be referred urgently to a gynaceological cancer service within two weeks.
Arrange for a serum CA125 test
A CA125 test measures the concentration of the cancer antigen-125 in the blood.
CA125 is found in elevated levels in most ovarian cancer cells compared with normal noncancerous cells.
However, a blood test showing high levels of CA125 is not conclusive evidence that a woman has ovarian cancer.
Some women have naturally high CA125 levels and there are other, less serious, conditions that can also increase CA125 levels in the blood.
If a woman has a CA125 test result of 35 or more IU/ml she should be referred for an ultrasound of her abdomen and pelvis to further investigate whether she has ovarian cancer.
Arrange for a pelvic ultrasound scan
If a woman’s CA125 test result is 35 IU/ml or more then you should refer her for an ultrasound of the abdomen and pelvis.
If an ultrasound scan is suggestive of ovarian cancer, according to the NICE clinical guideline, a woman should be referred urgently to a gynaceological cancer service within two weeks.