Diagnosis and staging

After a thorough medical history and examination, the following investigations should be undertaken:

• pelvic ultrasound (preferably transvaginal) if not already done
• routine blood and tumour marker tests (CA125, CEA and, in younger women, HCG, AFP, LDH)
• chest x-ray
• contrast-enhanced CT scan, PET/CT scan or MRI of the abdomen/pelvis.

Other investigations may be considered including fluid aspiration for cytology (pleural or peritoneal) and image-guided biopsy.

Staging for ovarian cancer is generally pathological following surgery.

Genetic testing

All women diagnosed with high-grade serous epithelial ovarian cancer should be offered genetic testing to look for the presence of mutations (e.g. in the BRCA1/2 genes) and should be referred to a familial cancer service.

Treatment planning

The multidisciplinary meeting (MDM) should occur within 2 weeks of the suspected or confirmed diagnosis.

Referral to fertility and menopause experts for premenopausal patients should be considered.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs
• inviting patients to participate in MDMs.

Checklist

Timeframe

Diagnostic investigations should be completed within 2 weeks of specialist review.