Improving early detection of ovarian cancer.

Ovarian cancer is the fifth most common cancer in women, accounting for more than 6700 new cases diagnosed each year in the U.K. The incidence has increased over the past 20-25 years, particularly in the 65 and over age group. The outcome for women with ovarian cancer is generally poor, with an overall five-year survival rate of less than 35%. Most women are diagnosed with advanced stage disease. Earlier diagnosis could improve survival outcome. Although 93% of women experience symptoms before diagnosis, a GP with an average sized practice may only see one case of ovarian cancer every five years. Evidence has shown that combining a number of symptoms that occur on a persistent or frequent basis (particularly more than 12 times per month) can have a sensitivity of up to 85% and a positive predictive value of the order of 0.2%. NICE recommends that serum CA125 should be the initial test followed by pelvic and abdominal ultrasound if the serum CA125 is abnormal. These tests should be requested by GPs prior to definitive referral. If both tests are abnormal, then these women should be referred on the two-week urgent referral pathway to the local specialist unit. When ultrasound, CA125 and clinical status suggest ovarian cancer, a CT scan of the pelvis and abdomen should be performed to establish the extent of disease.