Suspected ovarian cancer — DRCOG MCQ

Correct answer: D — Urgent referral for specialist ovarian-cancer assessment

The best answer is “Urgent referral for specialist ovarian-cancer assessment”. A complex adnexal mass with ascites in a symptomatic woman and raised CA125 is suspicious for ovarian cancer and requires urgent specialist referral. There is no reassuring CA125 threshold below 100 IU/mL in this context. Serial observation would delay staging and definitive diagnosis. The key distinction is between an investigation suitable for initial risk stratification and a finding that already meets an urgent suspected-cancer pathway. Persistent symptoms, postmenopausal bleeding, a suspicious mass or relevant family history must not be dismissed by one reassuring test. Referral and subsequent imaging or tissue diagnosis answer different stages of the pathway.

Reference: NICE CG122: Ovarian cancer recognition and initial management: https://www.nice.org.uk/guidance/cg122/chapter/recommendations