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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