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Possible ovarian cancer — MSRA MCQ

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Moderateall topics relevant for this examPossible ovarian cancerMSRA

A 63-year-old woman presents with 6 weeks of persistent abdominal bloating, early satiety and increased urinary frequency. She reports symptoms on most days, approximately 14 times per month. She has no dysuria, haematuria, vaginal bleeding or palpable abdominal mass. Abdominal and pelvic examination are unremarkable. Serum CA125 requested in primary care is 26 IU/mL. What is the most appropriate next step?

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Correct answer: D — Arrange an urgent direct-access ultrasound scan of the abdomen and pelvis

This woman has persistent symptoms suggestive of ovarian cancer: abdominal distension, early satiety and urinary frequency occurring frequently. In people aged 40 years and over, NICE recommends serum CA125 testing in primary care. For those aged 60–69 years, the threshold for urgent direct-access abdominal and pelvic ultrasound is CA125 of 24 IU/mL or greater. Her result of 26 IU/mL therefore meets the age-specific threshold, despite being below the historical 35 IU/mL threshold. A suspected cancer pathway referral is not the immediate step solely on this result when there is no ascites or pelvic/abdominal mass on examination. Referral is indicated if the ultrasound suggests ovarian cancer. Repeating CA125 delays the indicated diagnostic pathway. A routine ultrasound is insufficient because NICE specifies an urgent direct-access scan when the relevant age-specific CA125 threshold is met. IBS should not be presumed in a woman over 50 with new symptoms suggestive of IBS; ovarian cancer assessment is required first.

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer NICE NG12: Recommended actions organised by symptom and findings of primary care investigations (Last updated 15 April 2026) — https://www.nice.org.uk/guidance/NG12/chapter/recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations