Ovarian Cancer

🔍 When to Suspect

Women, especially aged 50+, with frequent (≥12 times/month), persistent symptoms: bloating, early satiety, pelvic/abdominal pain, or urinary urgency/frequency

From the full topic in The Ocean Library: Ovarian Cancer

🧭 When to suspect

Ovarian cancer is the leading cause of gynaecological cancer death in the UK, with around 7,500 new cases each year. Epithelial ovarian cancer (EOC) accounts for roughly 90% of cases – high-grade serous carcinoma is the commonest subtype, and most are now thought to arise in the distal fallopian tube. It peaks in the 60–69 age group, and more than 70% present at an advanced stage because the symptoms are vague, non-specific, and easily attributed to benign causes – and because there is no effective screening programme.

The primary-care task is therefore twofold: recognise the persistent symptom cluster (especially in women aged 50 or over), and act immediately on a pelvic or abdominal mass or ascites – referring on a suspected-cancer pathway without waiting for a CA125 result. Suspect ovarian cancer in a woman reporting any of persistent abdominal distension (bloating), early satiety and/or loss of appetite, pelvic or abdominal pain, or increased urinary urgency/frequency on a persistent or frequent basis – particularly more than 12 times per month. Also consider it with unexplained weight loss, fatigue, or change in bowel habit, and in any woman aged 50 or over with new irritable bowel syndrome (IBS)-type symptoms within the last 12 months, because IBS rarely presents for the first time at this age.

NICE updated NG12 in April 2026, replacing the old single threshold of 35 IU/mL with age-adjusted serum CA125 (cancer antigen 125) thresholds. In women aged 40 or over, measure CA125 and interpret it against the age-specific threshold below; in women aged 39 or under, do not use CA125 in isolation – consider an urgent, direct-access ultrasound instead.

Age (years)	Arrange urgent ultrasound of abdomen & pelvis if serum CA125 is
40–49	≥ 35 IU/mL
50–59	≥ 31 IU/mL
60–69	≥ 24 IU/mL
70–79	≥ 25 IU/mL
80 and over	≥ 31 IU/mL
39 and under	Do not use CA125 in isolation – consider urgent, direct-access ultrasound

⚠️ Common pitfall Labelling a woman aged 50 or over with new bloating and altered bowel habit as "IBS". IBS almost never presents for the first time at this age, so a confident benign label without testing is the classic way ovarian cancer is missed in primary care. In this group, the new symptom is the indication to test – measure CA125 (and examine the abdomen and pelvis) rather than reach for an antispasmodic.

Source: NICE NG12

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