GP Update

Case study: Diagnosing gynaecological cancers

Read through the case study below and think about how you would manage this patient presenting to your surgery


women die from gynaecological cancers each year

Ovarian Cancer, often referred to as 'The Silent Killer', is one of the most deadly gynaecological cancers in women because of it's vague symptoms that can be mistaken for other conditions. This presents challenges for diagnosing in primary care.

Gynaecological cancers are the 4th most common cancer in women in the UK, with nearly 7,700 deaths per year in the UK. There were 3,573 deaths from ovarian cancer in England and Wales in 2014.

Case study

A 53-year-old woman whose last period was 6 months ago presents to your surgery. She has experienced abdominal pain for the past 3 weeks, has had no other symptoms and has had the same sexual partner for 20 years.

What would you do?

  1. Secondary care referral
  2. Ultrasound/ CT
  3. Undertake investigations now
  4. Prescribe analgesia
  5. Prescribe antispasmodic
  6. Tell her that no action is needed at this stage

The correct answer is 3

Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer; if serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.

If normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound:

  • Assess her carefully for other clinical causes of her symptoms and investigate if appropriate including pelvic and abdominal ultrasound as over 20% of women with ovarian cancer do not have an elevated CA-125.
  • If no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent.

Make a referral

Find out how to refer your patients to The Royal Marsden.

Read more