Abstract
BackgroundWomen with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. We systematically identified and reviewed the consistency and quality of these documents.MethodsMEDLINE, Embase, guideline-specific databases and professional organisation websites were searched in March 2018 for relevant clinical guidelines, consensus statements and clinical pathways, produced by professional or governmental bodies. Two reviewers independently extracted data and appraised documents using the Appraisal for Guidelines and Research Evaluation 2 (AGREEII) tool.ResultsEighteen documents from 11 countries in six languages met selection criteria. Methodological quality varied with two guidance documents achieving an AGREEII score ≥ 50% in all six domains and 10 documents scoring ≥50% for “Rigour of development” (range: 7–96%). All guidance documents provided advice on possible symptoms of ovarian cancer, although the number of symptoms included in documents ranged from four to 14 with only one symptom (bloating/abdominal distension/increased abdominal size) appearing in all documents. Fourteen documents provided advice on physical examinations but varied in both the examinations they recommended and the physical signs they included. Fifteen documents provided recommendations on initial investigations. Transabdominal/transvaginal ultrasound and the serum biomarker CA125 were the most widely advocated initial tests. Five distinct testing strategies were identified based on the number of tests and the order of testing advocated: ‘single test’, ‘dual testing’, ‘sequential testing’, ‘multiple testing options’ and ‘no testing’.ConclusionsRecommendations on the initial assessment and investigation for ovarian cancer in symptomatic women vary considerably between international guidance documents. This variation could contribute to differences in the way symptomatic women are assessed and investigated between countries. Greater research is needed to evaluate the assessment and testing approaches advocated by different guidelines and their impact on ovarian cancer detection.
Highlights
Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation
While once considered a silent killer, it is recognised that symptoms occur in all stages of disease, studies differ in the symptoms they report and the positive predictive value (PPV) they attribute to each symptom [2,3,4,5]
An increasing range of tests are used in the initial investigation of symptomatic women for ovarian cancer, including the serum protein biomarker CA125 and imaging modalities such as transabdominal and transvaginal ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)
Summary
Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. An increasing range of tests are used in the initial investigation of symptomatic women for ovarian cancer, including the serum protein biomarker CA125 and imaging modalities such as transabdominal and transvaginal ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Algorithms that combine test results with patient characteristics such as age or menopausal state e.g. the Risk of Malignancy Index (RMI) and the ADNEX model, have been developed to help predict ovarian cancer risk in women presenting with a pelvic mass [6, 7]. There is very limited research evaluating tests for the initial investigation of symptoms within the primary care setting [8, 9], where most women with this condition first present [10]
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