New NICE guidance aims to improve ovarian cancer detection

In collaboration with Adfero

The National Institute for Health and Clinical Excellence (NICE) has published new guidance that advises GPs and other primary care professionals to offer more blood tests to women with possible symptoms of ovarian cancer.

In its first clinical guidance on the disease, NICE says that women - particularly those over the age of 50 - who visit their doctor with regular bloating, feeling full quickly, lower abdominal pain and the need to urinate urgently or frequently should be offered a blood test to measure a protein called CA125.

Patients whose CA125 raises concerns should then be offered an ultrasound scan of their abdomen and pelvis, and referred to a hospital specialist within two weeks if the ultrasound shows signs of ovarian cancer.

In addition, NICE is advising doctors to test women aged 50 or above who have been experiencing symptoms that suggest irritable bowel syndrome (IBS) within the previous 12 months. This is because IBS rarely develops for the first time in women over the age of 50, whereas the symptoms of ovarian cancer - which are similar to those of IBS - tend to become apparent in this age group.

According to NICE, more initial investigations in primary care settings could enable women to be referred to hospital specialists sooner, thereby improving their chances of surviving if they are diagnosed with the disease.

Early treatment can improve a woman's chances of surviving ovarian cancer, which is the fifth most common form of cancer among women.

But the CA125 isn't fool proof and GPs do need to be careful. It may be that a woman does have ovarian cancer even if their serum CA125 definitely isn't raised. For these women - and those who have high levels of CA125 but an ultrasound doesn't show anything - the guidance says that if there's no other apparent cause of the symptoms they should come back to their GP if their symptoms become more frequent and/or persistent.

Dr Fergus Macbeth, director of NICE's Centre for Clinical Practice, said: "Ovarian cancer is commonly referred to as the 'silent killer' as its symptoms are considered vague, and so can be confused with other conditions, like irritable bowel syndrome.

"This misconception can lead to many women being referred to inappropriate care pathways or being diagnosed once the cancer is at an advanced stage. The stage of the disease at diagnosis is the most important factor in predicting survival."

Dr Macbeth explained that persistent symptoms can be an "important indicator" of ovarian cancer, and that the new guidance recommends effective initial tests that can be undertaken by GPs and other healthcare professionals in such cases.

"In particular we recommend a specific blood test as a useful early way of determining if the disease is likely to be present. This test is already available on the NHS, but by offering it sooner and in primary care, we hope that it will lead to earlier diagnoses and treatment," he added.

Linda Facey, a guideline developer with personal experience of ovarian cancer, reiterated the importance of an early diagnosis of ovarian cancer, the symptoms of which can be "confusing".

She revealed: "I found that I was eating much less as I felt full very quickly during meals, but instead of losing weight, I constantly felt bloated and in pain.

"It's very easy for women to put their bodies on a backburner as they deal with busy family and working lives, but they should never ignore the possible symptoms. If the symptoms have been present for some time, women should go to see their GP and ask for the blood test. This will either help identify the cause early on, or give women the reassurance they may need."

The guidance has been welcomed by the Royal College of Obstetricians and Gynaecologists, whose president Dr Tony Falconer said that diagnosing ovarian cancer at the earliest possible stage is a "fundamental issue" for healthcare providers.

He said: "We support the NICE recommendation for GPs to offer the blood test (CA125) to women with suspected symptoms with the follow-up of an ultrasound scan.

"This approach will help detect problems at the earlier stages with more rapid referral to gynaecological oncologists. Early therapeutic intervention with surgery and chemotherapy should improve the prognosis for women."

Professor Jonathan Lederman, Cancer Research UK's ovarian cancer expert, said: "It's encouraging to see the early diagnosis of ovarian cancer being taken so seriously and we welcome any steps to help doctors diagnose women at the earliest stage.

"Cancer Research UK is helping to fund a trial developing screening for ovarian cancer using this blood test and ultrasound scans, which could make an even bigger impact on the number of women who survive the disease."