Quality statement 5: Treatment of high-risk stage 1 or stage 2 to 4 ovarian cancer
Quality statement
Adults with high-risk stage 1 ovarian cancer, or stage 2 to 4 ovarian cancer, have both surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer multidisciplinary team. [new 2025]
Rationale
It is important that treatment with a combination of surgery and chemotherapy is discussed as an option by the specialist gynaecological cancer multidisciplinary team (MDT) when adults with ovarian cancer are reviewed for treatment. Surgery with chemotherapy is associated with improved survival or reduced risk of recurrence. The discussion of this treatment option by a team of healthcare professionals supports adults having the opportunity to be treated with a combination of surgery and chemotherapy. Some adults, however, may not benefit from a combination of surgery and chemotherapy, may be too unwell or may decline this treatment option.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. Services may wish to monitor and compare unwarranted variation in achievement of the outcome measures within equality groups, such as age and comorbidity.
Process
Proportion of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer who have surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer MDT.
Numerator – the number in the denominator who have surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer MDT.
Denominator – the number of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, from patient records and records of multidisciplinary team meetings. The Cancer Outcomes and Services Data set (COSD) sets out standards for data to be collected on MDT meetings and care planning.
Outcome
a) Proportion of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer who received surgery.
Numerator – the number in the denominator who received surgery.
Denominator – the number of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Data is collected by NHS England, in the National Cancer Registration Dataset (NCRD)'s data on cancer treatments and Hospital Episode Statistics (HES) Admitted Patient Care (APC) dataset. The National Ovarian Cancer Audit collects data on the percentage of patients with stage 2 to 4 and unstaged non-borderline ovarian cancer who received surgery within 1 to 9 months of diagnosis.
b) Proportion of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer who received chemotherapy.
Numerator – the number in the denominator who received chemotherapy.
Denominator – the number of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Data on chemotherapy for all stages of ovarian cancer is collected by NHS England, in the HES APC and outpatient (OPC) datasets and the NDRS's data on cancer treatments and systemic Anti-Cancer Therapy (SACT) dataset. The National Ovarian Cancer Audit collects data on the percentage of patients with stage 2 to 4 and unstaged non-borderline ovarian cancer who received chemotherapy within 1 to 9 months of diagnosis.
c) Proportion of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer who received surgery and chemotherapy.
Numerator – the number in the denominator who received surgery and chemotherapy.
Denominator – the number of adults with a diagnosis of high-risk stage 1, or stage 2 to 4, ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Data on chemotherapy for all stages of ovarian cancer is collected by NHS England, in the HES APC and outpatient (OPC) datasets and the NDRS's data on cancer treatments and SACT dataset. The National Ovarian Cancer Audit collects data on the percentage of patients with stage 2 to 4 and unstaged non-borderline ovarian cancer who received surgery and chemotherapy within 1 to 9 months of diagnosis.
What the quality statement means for different audiences
Service providers (secondary and tertiary gynaecology services) ensure that referral and management pathways and network policies are in place so that adults with high-risk stage 1, or stage 2 to 4, ovarian cancer have both surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer MDT. They ensure that referral pathways are in place so that adults are referred to a specialist gynaecological cancer centre for surgery and, depending on local arrangements and resource, chemotherapy.
Healthcare professionals (gynaecological surgical oncologists and medical oncologists) are aware of local protocols to ensure that adults with high-risk stage 1, or stage 2 to 4, ovarian cancer have both surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer MDT. They are aware of local protocols to ensure referral to a specialist gynaecological oncology centre for surgery and, depending on local arrangements and resource, chemotherapy.
Commissioners have clinical protocols and network policies in place to ensure that adults with high-risk stage 1, or stage 2 to 4, ovarian cancer have both surgery and chemotherapy discussed as a treatment option by a specialist gynaecological cancer MDT. They commission services that can offer surgical procedures and recommended chemotherapy regimens, depending on the type, stage and grade of ovarian cancer.
Adults with high-risk stage 1, or stage 2 to 4, ovarian cancer are given the opportunity to decide whether they are treated with a combination of surgery and chemotherapy through review by a team of healthcare professionals.
Source guidance
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Ovarian, tubal and primary peritoneal cancer guidelines: recommendations for practice update 2024. British Gynaecological Cancer Society (2024), recommendations on page 85 ('approach to surgery', first recommendation listed); page 95 ('borderline tumours', first recommendation listed); page 97 ('germ cell tumours', first recommendation listed); page 100 ('sex-cord stromal tumours', first recommendation listed)
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Management of epithelial ovarian cancer. Scottish Intercollegiate Guidelines Network (SIGN) guideline 135 (2013, updated 2018), recommendation page 21, section 5.4.2
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Ovarian cancer: recognition and initial management. NICE guideline CG122 (2011, updated 2023), recommendations 1.2.2.1
Definitions of terms used in this quality statement
Surgery
The most appropriate form of surgery (including staging) depends on histopathology, grade and stage of disease. Age and reproductive choices are also factors if fertility-conserving surgery is an option. Surgery includes:
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surgical staging
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conservative surgery (also known as fertility-sparing surgery) which conserves the uterus and contra-lateral (opposite) ovary
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cytoreductive primary or secondary (debulking) surgery.
[NICE's guideline on ovarian cancer: recognition and initial management, recommendation 1.4.1.1, 1.4.1.2 and 1.5.1.1; NICE's interventional procedures guidance on maximal cytoreductive surgery for advanced ovarian cancer, section 2.3, and recommendations 1.1 to 1.4; and British Gynaecological Cancer Society's ovarian, tubal and primary peritoneal cancer guidelines: recommendations for practice update 2024, germ cell tumours (GCT) recommendations; GCT surgery, GCT systematic therapy and GCT follow-up (commentaries); sex-cord stromal tumours (SCST) recommendations; and management of suspected early-stage disease and management of advanced-stage and recurrent SCST (commentaries)].
Chemotherapy
The most appropriate chemotherapy depends on histopathology, and the stage and grade of disease:
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adjuvant (post-operative) chemotherapy
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neoadjuvant chemotherapy.
[NICE's guideline on ovarian cancer: recognition and initial management, recommendation 1.4.1.1, 1.4.1.2 and 1.5.1.1, and British Gynaecological Cancer Society's ovarian, tubal and primary peritoneal cancer guidelines: recommendations for practice update 2024, GCT recommendations; GCT surgery, GCT systematic therapy and GCT follow-up (commentaries); SCST recommendations; and management of suspected early-stage disease and management of advanced-stage and recurrent SCST (commentaries)].