# Ovarian cancer - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD28.01 - condition scope only, no dose · NICE NG12: Suspected cancer: recognition and referral (recommendation 1.5) - https://www.ncbi.nlm.nih.gov/books/NBK555330/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Ovarian cancer - disease-level clinical article (ovarian-cancer-full.txt) ## Treatment metadata - No drug therapy in primary care (Recognition & Referral) ## Complete treatment card ```text OVARIAN CANCER Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD28.01 - condition scope only, no dose · NICE NG12: Suspected cancer: recognition and referral (recommendation 1.5) - https://www.ncbi.nlm.nih.gov/books/NBK555330/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Ovarian cancer - disease-level clinical article (ovarian-cancer- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Most patients have vague symptoms - bloating, distention, early fullness, fatigue, bowel changes, urinary symptoms, back pain, painful sex, and weight loss [abdominal distension · back pain · fatigue · weight loss] - Abnormal uterine bleeding is not typically a presenting symptom of ovarian cancer [abnormal uterine bleeding] - Early disease is often mild or silent, so symptoms get missed and attributed to other causes - Cerebellar degeneration from a paraneoplastic reaction can cause unsteadiness, slurred speech, jerky eye movements, dizziness, and double vision, sometimes years before the tumor is found [dizziness · double vision · slurred speech · unsteadiness] - Paraneoplastic hypercalcemia can present as confusion, fatigue, constipation, belly pain, and increased thirst and urination [abdominal pain · confusion · constipation · excess thirst · fatigue] SIGNS - what you find (4) - Exam may reveal a palpable pelvic mass, ascites, or reduced breath sounds from a pleural effusion in advanced disease [ascites · pelvic mass] - A hard umbilical nodule (Sister Mary Joseph nodule) is a rare finding from metastasis [metastasis · umbilical lump] - A sudden crop of seborrheic keratoses can be a clue pointing to an occult malignancy - An irregular, firm, fixed, nodular mass or ascites on pelvic exam warrants imaging workup [ascites] TESTS (8) - CA-125 above 35 U/mL in a postmenopausal woman signals a high risk of malignancy - CA-125 is raised in most advanced cases but only about half of early-stage disease, so a normal level does not exclude cancer - CA-125 also rises with pregnancy, other cancers, and inflammatory conditions such as PID, adenomyosis, or endometriosis - HE4 is more sensitive than CA-125 in early disease, while CA-125 is more sensitive in late- stage disease - Transvaginal ultrasound is the first imaging test, looking for papillary or solid components, irregularity, ascites, and strong color Doppler flow - O-RADS 5 lesions carry a malignancy risk of at least 50 percent and warrant urgent gynecologic oncology referral - MRI is used when ultrasound findings are equivocal or CA-125 is normal, since it characterizes masses with high specificity - CT is often done before MRI to stage disease extent and plan surgery, though MRI better visualizes the ovarian tumor itself IF NOT THIS - what else fits (8) - Colon cancer is on the differential for an ovarian mass - Gastric adenocarcinoma is on the differential for ovarian cancer - Metastatic gastrointestinal carcinoma should be considered in the differential - Ovarian torsion is on the differential list - Peritoneal cyst is a differential consideration - Retroperitoneal mass should be considered in the differential - Uterine fibroids should be considered in the differential - Endometriosis is on the differential list for an ovarian mass Source StatPearls "Epithelial Ovarian Cancer" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line] Adult Malignant ovarian tumour; a Cairo GP recognises red-flag symptoms and refers urgently to gynae-oncology for surgical staging and chemotherapy, which are outside primary-care prescribing. - Refer Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Malignant ovarian tumour; a Cairo GP recognises red-flag symptoms and refers urgently to gynae-oncology for surgical staging and chemotherapy, which are outside primary-care prescribing. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - High-risk adnexal lesions (O-RADS 5) with malignancy risk >=50% require immediate referral to a gynecologic oncologist. RED FLAG - Irregular, firm, fixed, and nodular pelvic masses or ascites should prompt further evaluation with imaging studies. RED FLAG - Persistent abdominal bloating or distension, unexplained weight loss, or postmenopausal ovarian enlargement on ultrasound. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)