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GPs should offer ovarian cancer blood tests, say NHS guidelines

Testing women with any symptoms for high levels of CA125 protein could help more people survive the cancer


GPs should check women with ovarian cancer symptoms for high levels of the CA125 protein, according to the Nice guidelines

GPs should routinely offer blood tests for ovarian cancer to women who describe any of the symptoms associated with early stages of the disease, according to NHS guidance for England and Wales.

Checking for high levels of a protein called CA125 – a test at present usually done in hospitals – could help more women survive, guideline developers said.

Only about a third of the 6,800 women diagnosed each year survive for five years, though chemotherapy and surgery have helped improve survival rates significantly over the past 30 years. Offering blood tests in GP surgeries, followed, if necessary, by scans of the abdomen and pelvis, could mean earlier referral to specialists for diagnosis, said the National Institute for Health and Clinical Excellence (Nice).

Fergus Macbeth, director of the centre for clinical practice at Nice, said: “The stage of the disease at diagnosis is the most important factor on predicting survival. While the symptoms are nonspecific, their persistence can be an important indicator of the disease. Our guideline highlights some effective initial investigations that GPs and other healthcare professionals can undertake if ovarian cancer is ever a possibility.

“This test is already available on the NHS, but by offering it sooner and in primary care, we hope it will lead to earlier diagnoses and treatment.”

The Nice guidance covers detection, diagnosis and initial management of epithelial ovarian cancer, the most common type. Tests should be offered to women who regularly have symptoms such as bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently. Women of 50 or over who have experienced prolonged symptoms suggesting irritable bowel syndrome within the previous year should also be tested.

Although the tests are not 100% accurate, 80% of woman with advanced ovarian cancer have the protein.

Craig Dobson, a Hull GP who helped develop the guidance, said: “Ovarian cancer is difficult to diagnose from the symptoms alone. It is important for GPs to remember that irritable bowel syndrome rarely presents for the first time in women over 50. Conversely, most ovarian cancers present in women over the age of 50. Recurrent or prolonged symptoms require a diagnosis at any age.”

Linda Facey, a patient from Portsmouth on the guideline team, said: “Having been through repeated courses of chemotherapy and radiotherapy for ovarian cancer, I know how important it is for women to receive an early diagnosis. The symptoms can be confusing – I found that I was eating much less as I felt full very quickly during meals but instead of losing weight, I constantly felt bloated and in pain. It’s very easy for women to put their bodies on a backburner as they deal with busy family and working lives, but they should never ignore the possible symptoms.”

Clare Gerada, chair of the Royal College of GPs, welcomed the guidance. “Crucially, this is not about increasing GPs’ workloads. It is about working as effectively as possible with the tools available to us to achieve the best possible outcomes for women.”

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