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.
Key red flags
Persistent or frequent bloating, early satiety, pelvic or abdominal pain and urinary urgency occur especially in an older patient.
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.
Key medicines
Carboplatin with paclitaxelA standard epithelial ovarian regimen gives paclitaxel 175 mg/m² IV followed by carboplatin targeted at AUC 5–6 IV on day 1 every 21 days, usually for 6 cycles with protocolled adjustments.
OlaparibUse 300 mg orally twice daily continuously as tablets, with interruption and reduction to 250 mg then 200 mg twice daily for toxicity according to the licensed indication and maintenance duration.