April 2011
NICE clinical guideline 122
Fiona
1.1 Answer:
Measure serum CA125
1.2 Question:
Fionas serum CA125 level is 97 IU/ml. What should be
the next step for diagnosis?
Fiona
1.2 Answer:
Arrange for Fiona to have an ultrasound of her abdomen
and pelvis
1.3 Question:
The ultra sound comes back suggestive of ovarian
cancer. What should be the next step for diagnosis?
Fiona
Answer 1.3
Refer Fiona urgently to a gynaecological cancer
service (the national target in England and Wales for
referral for suspected cancer is currently 2 weeks)
Maria
2.1 Answer:
None
A pelvic or abdominal mass is highly suggestive of
ovarian cancer, and Maria should be referred urgently to
a gynaecological cancer service rather than having tests
in primary care
(the national target in England and Wales for referral for
suspected cancer is currently 2 weeks)
Hettie
3.1 Answer:
Measure serum CA125
3.2 Question:
Hetties serum CA125 level is 57 IU/ml. Which test would
you do next?
Hettie
3.2 Answer:
Arrange for Hettie to have an ultrasound of her abdomen
and pelvis
3.3 Question:
The ultrasound comes back normal. What is the next step
for diagnosis?
Hettie
3.3 Answer:
Ovarian cancer is unlikely. Further clinical assessment of Hetties
symptoms and signs should now be carried out.
If these point towards a different diagnosis, further investigation may
be required
If there is no obvious clinical cause of Hetties symptoms and no
specific signs, she should be advised to return if her symptoms persist
and/or become more frequent
Aamina
Next steps for diagnosis
4.1 Question:
You suspect a urinary tract infection. You offer antibiotics,
which are declined (SIGN), and send a mid-urine
specimen (MSU) for analysis. What is the next step for
diagnosis?
Aamina
4.1 Answer:
Await the result of the MSU analysis and act accordingly.
Treat as recommended if the result is positive, but if the
result is negative or equivocal it is important to see
Aamina again. In particular, you need to know if her
symptoms persist
4.2 Question:
The MSU result is negative but Aaminas symptoms
persist. You suspect ovarian cancer. What should you
do next?
Aamina
4.2 Answer:
Measure serum CA125
4.3 Question:
Aaminas serum CA125 level is 35 IU/ml. What should
you do next?
Aamina
4.3 Answer:
The cut-off value for a normal CA125 is below 35 IU/ml.
Arrange for Aamina to have ultrasound of her abdomen
and pelvis
4.4 Question:
The ultrasound is suggestive of ovarian cancer. What is
the next step for diagnosis?
Aamina
4.4 Answer:
Refer Aamina urgently to a gynaecological cancer
service (the national target in England and Wales for
referral for suspected cancer is currently 2 weeks)