Clinical Review

Diagnosis of ovarian cancer

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4443 (Published 01 September 2015) Cite this as: BMJ 2015;351:h4443
  1. Sudha Sundar, senior lecturer in gynaecological oncology1,
  2. Richard D Neal, professor of primary care medicine2,
  3. Sean Kehoe, professor of gynaecological cancer1
  1. 1Pan Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospital NHS Trust, Birmingham, and School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
  2. 2North Wales Centre for Primary Care Research, Bangor University, Wales, UK
  1. Correspondence to: S Sundar s.s.sundar{at}bham.ac.uk

The bottom line

  • NICE recommends symptom triggered testing using sequential CA125 and ultrasonography for ovarian cancer

  • Ovarian cancer is most common in the postmenopausal age group

  • CA125 is not a specific marker in premenopausal women and may be increased during menstruation and in other conditions

  • Ovarian cysts are common in premenopausal women and may be physiological

  • Ultrasound findings of simple or unilocular cysts (that is, fluid-containing cysts) measuring <5 cm on ultrasonography are reassuring and associated with less than a 1% risk of malignancy

  • All women with a diagnosis of high grade serous ovarian cancer may be offered routine testing for BRCA. Women with known BRCA mutations may be offered risk reducing surgery to remove the fallopian tubes and ovaries

Ovarian cancer is the seventh most common cancer in women worldwide, with 239 000 new cases diagnosed in 2012.1 As with many other types of cancer, geographical variation in the incidence of and mortality from ovarian cancer is substantial, with a higher incidence in economically developed regions of the world.2 Incidence is highest in the 50-70 year old age group, with 75% of cases diagnosed in women aged more than 55 years.3 In 80% of women the disease will be advanced at presentation, with a low five year survival rate; the all stage five year survival in the United Kingdom is 46%.4 This low survival rate in the UK has been recognised in the International Cancer Benchmarking Partnership and has been attributed at least partly to less timely diagnosis.5 This review summarises the presenting features, diagnostic tests, risk factors, and groups at high risk of ovarian cancer and is aimed at primary care practitioners and hospital doctors in other specialties.

Sources and selection criteria

We carried out an electronic search of PubMed, Medline, Embase, the Cochrane Library, and the Cochrane database of systematic …

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