Women who have ovarian cancer could have a greater chance of surviving the disease if more blood tests are offered in primary care. New guidance published today (27 April) from NICE calls for improved testing to allow faster diagnoses.

Ovarian cancer is the fifth most common cancer in women, with around 6,800 women being diagnosed every year in the UK[1]. Of these, nearly two-thirds (65%) will not live beyond five years of their diagnosis. Chemotherapy and surgery can be effective treatments, but women could have a greater chance of surviving the disease if it is identified earlier on.

In its first clinical guideline on ovarian cancer, the National Institute for Health and Care Excellence (NICE) is calling for more initial investigations to take place in primary care settings, such as GP surgeries - this is so that women can be referred to hospital specialists sooner and begin treatment.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE 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.

"While the symptoms are nonspecific, their persistence can be an important indicator of the disease. Our guideline highlights some effective initial investigations that GPs and other healthcare professionals can undertake if ovarian cancer is ever a possibility. 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."

NICE is advising GPs and other primary care professionals to offer women (particularly those over 50) a blood test to measure the level of a protein called CA125 if they present with the following symptoms on a regular basis - bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently.

Based on the results of this test, women should then be offered an ultrasound scan of their abdomen and pelvis. If this suggests ovarian cancer, they should then be referred to see hospital specialists within two weeks; this is the existing national target set by the Department of Health.

Mr Sean Duffy, Medical Director of Yorkshire Cancer Network and Chair of the Guideline Development Group said: "Ovarian cancer is a very serious disease but it can be successfully treated if diagnosed early.

"GPs and other primary care professionals can play a key role in facilitating earlier diagnoses by carrying out some of the initial investigations that would otherwise take place in hospitals, such as blood tests.

"I hope that the NICE guideline will support healthcare professionals in their day-to-day practice and give all women the greatest chances possible to survive the disease."

Mr Charles Redman, a Consultant Gynaecological Oncologist and Guideline Developer said: "Delayed presentation coupled with a lack of awareness around the possible symptoms, unfortunately mean that far too many women are being referred to hospitals for suspected ovarian cancer once their disease is already at an advanced stage. This is frustrating as the stage of the disease at its diagnosis is crucial in determining which treatments can then be offered.

"The NICE guideline seeks to ensure that women receive diagnosis and treatment in a timelier manner. The earlier the cancer is identified, the more likely treatment is to be successful."

Dr Craig Dobson, a GP and Guideline Developer said: "Ovarian cancer is difficult to diagnose from the symptoms alone. It is important for GPs to remember that irritable bowel syndrome rarely presents for the first time in women over fifty. Conversely, most ovarian cancers present in women over the age of fifty. Recurrent or prolonged symptoms require a diagnosis at any age."

Ms Linda Facey, a Guideline Developer with personal experience of ovarian cancer said: "Having been through repeated courses of chemotherapy and radiotherapy for ovarian cancer, I know how important it is for women to receive an early diagnosis. The symptoms can be confusing - 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."

Ends

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Notes to Editors

About the clinical guideline

1. For further information about NICE clinical guideline 122 on the recognition and initial management of ovarian cancer, visit: www.nice.org.uk/CG122.

2. The new guideline from NICE looks at the detection, diagnosis and initial management of epithelial ovarian cancer. This is the most common type of the ovarian cancer and is when cancerous cells grow on the surface of the ovaries. The disease becomes "advanced" when the cancerous cells spread outside of the ovaries and into the abdominal organs or to other parts of the body (e.g. liver or lungs).

3. To avoid inaccurate and delayed diagnoses, NICE is also advising GPs to test women aged 50 or above for ovarian cancer if they have experienced prolonged symptoms within the last 12 months that suggest irritable bowel syndrome (IBS). This is because IBS rarely presents for the first time in women of this age.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.