Practice Guidelines

Recognition and initial management of ovarian cancer: summary of NICE guidance

BMJ 2011; 342 doi: (Published 21 April 2011) Cite this as: BMJ 2011;342:d2073
  1. C Redman, consultant gynaecological oncologist1,
  2. S Duffy, medical director2,
  3. N Bromham, researcher3,
  4. K Francis, senior researcher3
  5. on behalf of the Guideline Development Group
  1. 1University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, UK
  2. 2Yorkshire Cancer Network, Harrogate HG2 7RY, UK
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK

Ovarian cancer is the leading cause of death from gynaecological cancer in the United Kingdom, and its incidence is rising. It is the fifth most common cancer in women, with a lifetime risk of about 2% in England and Wales.1 The outcome for women with ovarian cancer is generally poor, with an overall five year survival rate of less than 35%.2 Most women have had symptoms for months before presentation, and as these are frequently non-specific, delays often occur between presentation and referral to a specialist.3 Greater awareness of the disease and appropriate initial investigations in primary and secondary care are needed to enable earlier referral and optimum treatment. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the recognition and initial management of women with ovarian cancer.4


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Detection in primary care

Awareness of symptoms and signs

  • Refer the woman urgently to a gynaecological cancer service if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not caused by known uterine fibroids). Urgent referral for suspected cancer should be within the national target in England and Wales, which is currently two weeks. For recommendations on the support and information needs of people with suspected cancer, see NICE’s guidelines.5

  • Carry out tests in primary care if a woman (especially if aged 50 years or over) reports having any of the following symptoms on a persistent or frequent basis—particularly more than 12 times a month:

    • -Persistent abdominal distension (women often refer to this as …

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