AKT · Obstetrics & gynaecology/Gynae oncology & screening

Ovarian cancer

Epithelial (mostly high-grade serous); BRCA-linked

Overview

The gynaecological cancer with the highest mortality — usually epithelial (high-grade serous), presenting LATE with vague abdominal symptoms. CA125 and USS (Risk of Malignancy Index) guide referral; BRCA mutations raise risk.

Recognise

Vague, persistent: bloating, early satiety, abdominal/pelvic pain, urinary urgency
Abdominal distension, ascites, pelvic/abdominal mass
Often advanced at diagnosis

Red flags

Persistent bloating/abdominal symptoms in a woman >50 → check CA125 (and refer)

Differentials & how to tell them apart

IBS (new, >50)new IBS-type symptoms over 50 warrant CA125 — do not assume IBS

Ovarian cyst (benign)simple cyst, normal CA125, low RMI

GI/other malignancyimaging, endoscopy

Fibroidsuterine, USS

Investigations

CA125 first (if ≥35 → USS abdomen/pelvis). Risk of Malignancy Index (RMI = USS × menopausal status × CA125). CT for staging; do not biopsy a resectable mass before MDT.

Management

Cytoreductive surgery + platinum-based chemotherapy

1CA125 → USS → RMI → refer to gynae-oncology. Treatment: cytoreductive (debulking) surgery + platinum-based chemotherapy.
2BRCA testing; PARP inhibitor maintenance for eligible patients.

Surgery (debulking) + platinum-based chemotherapy — mainstay

PARP inhibitors — maintenance, esp. BRCA-mutated

Key points

New IBS-type symptoms in a woman over 50 should prompt a CA125 — late presentation is why mortality is high. BRCA1/2 substantially raise risk (and breast cancer).

Monitor & prognosis

CA125 response; recurrence surveillance.

Poor due to late presentation; better if early/optimally debulked.

Source: NICE CG122/NG12