Hidoc Bulletin

Introduction:

Although ovarian cancer is not a common type of cancer observed in women, it is one 
of the dreadful cancers with high mortality rates. It requires an early diagnosis and 
proper treatment follow-up of the patients. In early suspicion and diagnosis of ovarian 
cancer the general practitioners or the primary care doctors can play a major role. 
Detecting ovarian cancer at primary care is highly challenging due to the nonspecific 
symptoms. Based on the guidelines published by the National Institute for Health and 
Clinical Excellence (NICE) performing CA125 test could be useful in detecting ovarian 
cancer or ovarian cysts. As postmenopausal women with ovarian cysts or cancer is 
expected to have a different level of serum CA125 compared to the threshold level of 
35 IU/ml. Moreover, performing ultrasound scans as a tool of first line investigation can 
provide better results in diagnosing ovarian cancer among women. Adhering to the NICE guidelines the general practitioners can suspect and diagnose ovarian cancer.

The guidelines indicate: 

1. If a woman (especially if 50 or over) reports having any of the symptoms like abdominal distention, feeling full or loss of appetite, abdominal pain, increased urinary frequency persisting or having on a frequent basis, particularly more than 12 times per month, the individual can be suspected of having ovarian cancer

2. Women aging >50 years had a threefold incidence of ovarian cancer compared to others

3. Women with abnormal CA125 test results (>35 U/mL), 15.2 percent of those aged ≥50 years and 3.4 percent of those aged <50 years are expected to have ovarian cancer. 

4. The probability of ovarian cancer is 3 percent in women with a CA125 level of 51 U/mL and it is recommended for urgent cancer referral by NICE. 

CA125:

The CA125 test can be highly useful in detecting ovarian cancer in general practice 
but it can detect non ovarian cancers as well which include chest, abdomen, and 
pelvis. An elevation of 49, 47 and 36 percent in the levels of CA125 observed in 
women diagnosed with pancreatic, lung, and uterine cancer, respectively and thus 
the GP’s need to have the knowledge of these as well. Therefore, while managing a 
symptomatic woman who has elevated CA125 levels clinicians need to consider 
performing appropriate investigations for other cancers also in order to avoid 
diagnostic delay. The tumor marker CA125 may also lack sensitivity which can lead to 
false results, therefore, the physicians should also consider other imaging techniques 
in order to confirm the suspect of ovary cancer among women and further research 
in this area also needs to be initiated in order to get a more clear picture for the use 
of CA125