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Detection of Ovarian Cancer in Primary Care
(1) Fabian Lee, Foundation Year 2. (2) Gbolahan Somoye, Senior Registrar. (3) Sherif Saleh, Consultant Gynaecologist.
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Gynaecology Department, Aberdeen Royal Infirmary, NHS Grampian, Scotland, UK.
Email: [email protected]
Objectives
Ovarian cancer is termed ‘silent killer’
and is the most common form of
gynaecological cancer with an incidence
rate of 20 per 100,000.
It is also widely recognised that most
women with ovarian cancer have nonspecific symptoms making it particularly
difficult to detect, especially in primary
care.
Majority of women with ovarian cancer
present in the advanced stages, therefore
the poor outcome.
This study aims to examine the quality of
clinical information of urgent referrals for
suspected ovarian cancer as provided by
primary care physicians to a specialist
gynae-oncology service in the North of
Scotland, UK.
Methods
96 referral letters for suspected ovarian
cancer from primary care were reviewed
from October 2010 to September 2011.
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Conclusions
Outcome of each referral were
categorised as ‘malignancy’ or ‘no
malignancy’.
Referral letters from primary to secondary
care are lacking important clinical
information.
We reviewed the following clinical
information:
1)physical examination findings (ascites and/or
pelvic/abdominal mass – not obviously uterine fibroids);
2)duration of symptoms,
3)specific symptoms (any one/more of abdominal bloating,
early satiety, abdominal/pelvic pain, urinary symptoms, or
age >50 with symptoms of IBS), and;
1)general symptoms (any one or more of unexplained
weight loss, fatigue, altered bowel habit, in which ovarian
cancer is suspected).
Results
Duration of symptoms were only
mentioned in 56% of referrals.
No details of any specific and/or general
symptoms in 18% of referrals.
All referral letters to gynaecological
cancer services are evaluated by senior
clinicians and prioritised accordingly
based on presenting symptoms, physical
examination findings and investigation
results to determine the urgency of action
required (eg: Outpatient clinic
appointment or In-patient admission).
Obviously, the challenge presented by
ovarian cancer is to diagnose the disease
early as possible, therefore primary care
physicians play a major role in ensuring
that patients with potential ovarian
malignancies are directed to the most
appropriate clinical pathway as soon as.
References
NICE Clinical Guideline 122 – Ovarian
Cancer: The Recognition And Initial
Management Of Ovarian Cancer.
http://www.nice.org.uk/guidance/CG122