2WW Gynaecology Referral Form - and suspected Ovarian cancer

Please note, following a recent review of NICE NG12 2015 guidance, the following changes to the Urgent Suspected Cancer (USC) referral pathway for suspected ovarian cancer.

Patients aged 40 years and over

For women, trans men and non-binary people with female reproductive organs who present with persistent symptoms suggestive of ovarian cancer, please:

· Carry out CA125 test

· Arrange an urgent ultrasound scan of the abdomen and pelvis OR

· Refer as USC via normal local pathway

depending on the patient's age and CA125 result.

CA125 thresholds for USC referral:

· 40-49 years: ≥35 IU/ml

· 50-59 years: ≥31 IU/ml

· 60-69 years: ≥24 IU/ml

· 70-79 years: ≥25 IU/ml

· 80+ years: ≥31 IU/ml

Patients aged 39 years and under

For women, trans men and non-binary people with female reproductive organs aged 39 years or under with persistent symptoms suggestive of ovarian cancer:

· Do not use CA125 in isolation for decision making.

· Ovarian cancer is uncommon in this age group, but diagnosis is often delayed and a normal CA125 does not exclude malignancy.

· Consider an urgent ultrasound scan of the abdomen and pelvis and/or a USC referral based on clinical assessment and level of concern.

Important reminder

A normal CA125 result should not provide reassurance where significant clinical concern remains. The Non-Specific Symptoms (NSS) pathway remains available for patients with ongoing concerning symptoms despite normal investigations, including a normal CA125.

Please continue to use clinical judgement and refer via the most appropriate pathway when cancer remains a possibility.

Key documents

  • Clinical support group
    • Cancer, Palliative Care, Pain and Older People
    • Women's and Sexual Health

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