Synopsis
Recognise persistent symptom patterns, use CA125 and ultrasound appropriately in primary care, establish specialist stage and tissue, and sequence cytoreductive surgery, platinum treatment, genetics and maintenance therapy.
- Persistent frequent bloating, early satiety, pelvic pain or urinary urgency in an older woman warrants structured ovarian-cancer assessment.
- A palpable pelvic mass or ascites requires urgent specialist referral; do not wait for CA125 before referring.
- Without a mass, measure CA125 first and arrange pelvic and abdominal ultrasound when it is 35 units/mL or above.
- Contrast CT stages suspected disease and estimates operability, but small peritoneal deposits can remain occult.
- Obtain a core biopsy before neoadjuvant chemotherapy whenever safely feasible; CA125 and imaging are not histology.
- Primary cytoreduction is preferred when complete macroscopic clearance is realistically achievable with acceptable morbidity.
- Carboplatin–paclitaxel is the standard systemic backbone, followed by molecularly selected maintenance where indicated.
- Offer germline testing at diagnosis and complete tumour BRCA or HRD testing early enough to guide maintenance treatment.
Key red flags
Persistent or frequent bloating, early satiety, pelvic or abdominal pain and urinary urgency occur especially in an older patient.
Ascites, a pelvic mass, nodularity or pleural effusion suggests advanced disease and needs urgent specialist assessment.
Vomiting, distension and obstipation suggests malignant bowel obstruction.
Sudden severe unilateral pelvic pain with nausea suggests torsion and requires emergency gynaecological review.
A first-degree family pattern of ovarian, early breast, pancreatic, prostate or Lynch-associated cancers raises inherited risk.
Rapid breathlessness, unilateral leg swelling or pleuritic pain suggests effusion or venous thromboembolism.
Colic, vomiting, distension and failure to pass stool or flatus requires emergency assessment for level, perforation and reversibility.
Investigation priorities
Triage persistent compatible symptoms in women without an obvious pelvic mass or ascites.
Management branches
A patient, especially aged 50 or over, reports persistent bloating, early satiety, pelvic pain or urinary frequency.
- Examine abdomen and pelvis; a mass or ascites warrants urgent referral rather than waiting for a marker.
- In primary care without an obvious mass, measure CA125 and arrange pelvic and abdominal ultrasound when it is 35 units/mL or above.
- Refer suspicious ultrasound urgently; if tests are normal but symptoms persist, investigate alternative gastrointestinal, urinary and gynaecological causes and safety-net.