General Practitioners Role in Diagnosing Ovarian Cancer

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.

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