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Ovarian cancer overview

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Ovarian cancer

About

What is covered

This pathway covers the recognition and management of ovarian cancer.
Ovarian cancer is the leading cause of death from gynaecological cancer in the UK, and its incidence is rising. It is the fifth most common cancer in women.
The overall 5-year survival rate for women with ovarian cancer is below 35%. Most women present with advanced disease, having had symptoms for months before presentation, and there are often delays between presentation and specialist referral. There is a need for greater awareness of ovarian cancer, and for initial investigations in primary and secondary care that enable earlier referral and optimum treatment.
This pathway does not cover the entire care pathway for ovarian cancer in detail. It focuses on areas where there is uncertainty or wide variation in clinical practice with regard to the detection, diagnosis and management of ovarian cancer. The recommendations are applicable to women with epithelial ovarian cancer (the most common type of ovarian cancer), as well as women with fallopian tube carcinoma, primary peritoneal carcinoma or borderline ovarian cancer.

Updates

Updates to this pathway

26 April 2016 Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (NICE technology appraisal guidance 389) added to second-line and subsequent chemotherapy.
26 January 2016 Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy (NICE technology appraisal guidance 381) added to second-line and subsequent chemotherapy.
25 August 2015 Bevacizumab for treating relapsed, platinum-resistant epithelial ovarian, fallopian tube or primary peritoneal cancer (terminated appraisal) (NICE technology appraisal guidance 353) added to second-line and subsequent chemotherapy.
26 November 2013 'Ultra-radical (extensive) surgery for advanced ovarian cancer' (NICE interventional procedure guidance 470) added to primary surgery.
22 May 2013 Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (NICE technology appraisal guidance 284) added to first-line chemotherapy and Bevacizumab in combination with gemcitabine and carboplatin for treating the first recurrence of platinum-sensitive advanced ovarian cancer (NICE technology appraisal guidance 285) added to second-line and subsequent chemotherapy.
23 October 2012 Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours (NICE technology appraisal guidance 265) added to preventing skeletal-related events in women with bone metastases.
25 May 2012 Ovarian cancer (NICE quality standard 18) added to the pathway.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

The recognition and management of ovarian cancer

What is covered

This pathway covers the recognition and management of ovarian cancer.
Ovarian cancer is the leading cause of death from gynaecological cancer in the UK, and its incidence is rising. It is the fifth most common cancer in women.
The overall 5-year survival rate for women with ovarian cancer is below 35%. Most women present with advanced disease, having had symptoms for months before presentation, and there are often delays between presentation and specialist referral. There is a need for greater awareness of ovarian cancer, and for initial investigations in primary and secondary care that enable earlier referral and optimum treatment.
This pathway does not cover the entire care pathway for ovarian cancer in detail. It focuses on areas where there is uncertainty or wide variation in clinical practice with regard to the detection, diagnosis and management of ovarian cancer. The recommendations are applicable to women with epithelial ovarian cancer (the most common type of ovarian cancer), as well as women with fallopian tube carcinoma, primary peritoneal carcinoma or borderline ovarian cancer.

Updates

Updates to this pathway

26 April 2016 Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer (NICE technology appraisal guidance 389) added to second-line and subsequent chemotherapy.
26 January 2016 Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy (NICE technology appraisal guidance 381) added to second-line and subsequent chemotherapy.
25 August 2015 Bevacizumab for treating relapsed, platinum-resistant epithelial ovarian, fallopian tube or primary peritoneal cancer (terminated appraisal) (NICE technology appraisal guidance 353) added to second-line and subsequent chemotherapy.
26 November 2013 'Ultra-radical (extensive) surgery for advanced ovarian cancer' (NICE interventional procedure guidance 470) added to primary surgery.
22 May 2013 Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (NICE technology appraisal guidance 284) added to first-line chemotherapy and Bevacizumab in combination with gemcitabine and carboplatin for treating the first recurrence of platinum-sensitive advanced ovarian cancer (NICE technology appraisal guidance 285) added to second-line and subsequent chemotherapy.
23 October 2012 Denosumab for the prevention of skeletal-related events in adults with bone metastases from solid tumours (NICE technology appraisal guidance 265) added to preventing skeletal-related events in women with bone metastases.
25 May 2012 Ovarian cancer (NICE quality standard 18) added to the pathway.

Sources

NICE guidance and other sources used to create this pathway.
Ultra-radical (extensive) surgery for advanced ovarian cancer (2013) NICE interventional procedure guidance 470
Improving outcomes in gynaecological cancers (1999) Cancer service guidance
Ovarian cancer (2012) NICE quality standard 18

Quality standards

Ovarian cancer

These quality statements are taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statements

Symptoms and CA125

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer are offered a CA125 test.

Quality measure

Structure
Evidence of local arrangements to ensure all women aged 50 years and over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer are offered a CA125 test.
Process
Proportion of women aged 50 years and over reporting at least one symptom occurring persistently or frequently that suggests ovarian cancer who receive a CA125 test.
Numerator – the number of women in the denominator receiving a CA125 test.
Denominator – the number of women aged 50 years and over reporting at least one symptom occurring persistently or frequently that suggests ovarian cancer.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer to be offered a CA125 test.
Healthcare professionals offer a CA125 test to women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer.
Commissioners ensure they commission services that provide CA125 tests for women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest of ovarian cancer.
Women aged 50 years or over with one or more symptoms associated with ovarian cancer that occur often (more than 12 times a month) or for a while (over a month) are offered a blood test called a CA125 test. The CA125 test measures the amount of a protein produced by some ovarian cancers in the blood. Symptoms associated with ovarian cancer include feeling 'bloated', loss of appetite or feeling full quickly, pain in the abdomen or pelvic area, needing to pass urine urgently or more often than usual, and unexplained tiredness, weight loss or changes in bowel habit (for example, constipation or diarrhoea).

Source clinical guideline references

NICE clinical guideline 122 recommendations 1.1.1.2, 1.1.1.5, 1.1.2.1 (key priorities for implementation), 1.1.1.3 and 1.2.1.1.

Data source

Structure
Local data collection.
Process
Local data collection. Contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): primary care, criteria 2, 3 and 4.

Definitions

The statement applies to women aged 50 years and over. However women under 50 years should be offered the CA125 test if clinically appropriate.
Symptoms suggestive of ovarian cancer include:
  • persistent abdominal distension (women often refer to this as 'bloating')
  • feeling full and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • unexplained weight loss
  • unexplained fatigue
  • unexplained changes in bowel habit or
  • symptoms that suggest irritable bowel syndrome if the woman is 50 years or over.
Persistent is defined as at least 1 month.
Frequent is defined as 12 times per month.

Equality and diversity considerations

The statement includes women aged 50 years and over as they have a higher risk of developing ovarian cancer than women aged under 50 years based on the epidemiological profile of the disease. Over 80% of women diagnosed with ovarian cancer are aged over 50 years. The highest age-specific incidence rates are seen for women aged 80–84 years at diagnosis (69 per 100,000), dropping to 64 per 100,000 in women aged 85 and over (Cancer Research UK). However ovarian cancer can occur in women aged under 50 years, and incidence increases with age, with the highest age-specific incidence rates for women under 50 years occurring in those aged 45–49 years at diagnosis (19 per 100,000). Therefore women under 50 years should be offered the CA125 test if clinically appropriate.

Ultrasound

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women with raised CA125 have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.

Quality measure

Structure
Evidence of local arrangements to ensure all women with raised CA125 have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.
Process
Proportion of women with raised CA125 who have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.
Numerator – the number of women in the denominator who have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.
Denominator – the number of women with raised CA125.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women with raised CA125 to have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results. To meet the 2-week timescale, service providers ensure systems are in place for ultrasounds to be arranged directly from primary care.
Healthcare professionals ensure women with raised CA125 have an ultrasound of their abdomen and pelvis within 2 weeks of receiving the CA125 test results.
Commissioners ensure they commission services that provide an ultrasound of the abdomen and pelvis within 2 weeks of receiving the test results for women with raised CA125.
Women with raised CA125 levels in their blood have an ultrasound scan of their abdomen and pelvis within 2 weeks of receiving the results of their blood test.

Source clinical guideline references

NICE clinical guideline 122 recommendations 1.1.2.2 (key priority for implementation) and 1.2.3.1.
The Royal College of Radiologists iRefer: Making the best use of clinical radiology: referral guidelines recommendation CA42 diagnosis (US).

Data source

Structure
Local data collection.
Process
Local data collection. Contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): primary care, criteria 5.

Definitions

Raised CA125 is defined as 35 IU/ml or greater.

Advice

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women with normal CA125, or raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, are reassessed by their GP within 1 month.

Quality measure

Structure
Evidence of local arrangements and written clinical protocols to ensure women with normal CA125, or raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, are reassessed by their GP within 1 month.
Process
a) Proportion of women with normal CA125 and no confirmed diagnosis but continuing symptoms, who are reassessed by their GP within 1 month.
Numerator – the number of women in the denominator who are reassessed by their GP within 1 month.
Denominator – the number of women with normal CA125 and no confirmed diagnosis but continuing symptoms.
b) Proportion of women with raised CA125 but normal ultrasound and no confirmed diagnosis but continuing symptoms, who are reassessed by their GP within 1 month.
Numerator – the number of women in the denominator who are reassessed by their GP within 1 month.
Denominator – the number of women with raised CA125 but normal ultrasound, and no confirmed diagnosis but continuing symptoms.

Description of what the quality statement means for each audience

Service providers ensure systems and written clinical protocols are in place for women with normal CA125, or raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, to be reassessed by their GP within 1 month.
GPs proactively reassess women who have normal CA125, or raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, within 1 month.
Commissioners ensure they commission services that reassess women who have normal CA125, or raised CA125 but normal ultrasound, with no confirmed diagnosis but continuing symptoms, by their GP within 1 month.
Women with normal CA125 results, or raised CA125 but a normal ultrasound scan, with no confirmed diagnosis but continuing symptoms, are reassessed by their GP within 1 month.

Source clinical guideline references

NICE clinical guideline 122 recommendations 1.1.2.4 (key priority for implementation) and 1.1.1.4.

Data source

Structure
Local data collection.
Process
a) and b) Local data collection.

Definitions

Normal CA125 is defined as less than 35 IU/ml.
Raised CA125 is defined as 35 IU/ml or greater.
1 month starts from receipt of the normal CA125 or normal ultrasound result.
Symptoms suggesting ovarian cancer include:
  • persistent abdominal distension (women often refer to this as 'bloating')
  • feeling full and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • unexplained weight loss
  • fatigue
  • changes in bowel habit or
  • symptoms that suggest irritable bowel syndrome if the woman is 50 or over.
Non-ovarian cancer reasons for raised CA125 (from the United Kingdom Collaborative Trial for Ovarian Cancer Screening protocol list:
Physiological conditions:
  • ovulation
  • pregnancy
  • retrograde menstruation.
Benign gynaecological conditions:
  • endometriosis
  • benign ovarian cysts
  • uterine leiomyomata (fibroids).
Other non-malignant disease:
  • autoimmune disease (such as Sjogrens syndrome, polyarteritis nodosa, systemic lupus erythematosus)
  • sarcoidosis
  • benign gastrointestinal diseases (such as colitis, diverticulitis)
  • chronic active hepatitis
  • cirrhosis
  • pericarditis
  • pancreatitis (acute and chronic)
  • renal disease with serum creatinine greater than 2.0.
Non-ovarian malignant conditions:
  • malignant ascites
  • disseminated malignancy (such as breast, lung)
  • disseminated malignancies from any site involving pleural or peritoneal surfaces
  • a proportion of:
    • non-Hodgkin's lymphoma
    • pancreatic cancers
    • cervical cancers
    • endometrial cancers.

Malignancy indices

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women with a risk of malignancy index (RMI I) score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.

Quality measure

Structure
Evidence of local arrangements to ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.
Process
Proportion of women with an RMI I score of 250 or greater referred to a specialist gynaecological cancer multidisciplinary team.
Numerator – the number of women in the denominator referred to a specialist gynaecological cancer multidisciplinary team.
Denominator – the number of women with an RMI I score of 250 or greater.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.
Healthcare professionals ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.
Commissioners ensure they commission services for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.
Women with suspected ovarian cancer have their 'risk of malignancy' or RMI I score calculated (using their CA125 and ultrasound results and whether they have had the menopause) to help find out if ovarian cancer is likely. Women with a high RMI I score (250 or more) are referred to a team of healthcare professionals who are experienced in treating women with ovarian cancer, called a specialist gynaecological cancer multidisciplinary team.

Source clinical guideline references

NICE clinical guideline 122 recommendation 1.2.2.1 (key priority for implementation).

Data source

Structure
Local data collection.
Process
Local data collection. Also contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): secondary care, criteria 3.

Definitions

NICE clinical guideline 122 defines how RMI I should be calculated in appendix D. RMI I combines three pre-surgical features: CA125, menopausal status (M) and ultrasound score (U). The RMI is a product of the ultrasound scan score, the menopausal status and the CA125 level (IU/ml).
RMI = U x M x CA125
The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2-5).
The menopausal status is scored as 1 = pre-menopausal and 3 = post-menopausal. The classification of 'post-menopausal' is a woman who has had no period for more than 1 year or a woman over 50 who has had a hysterectomy.
CA125 is measured in IU/ml and can vary between 0 and hundreds or even thousands of units.
Specialist core members of a multidisciplinary team are described in the National Cancer Peer Review Programme's Manual for Cancer Services in gynaecology measure 11-2E-101.

Initial staging CT

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women who are offered staging for ovarian cancer, following ultrasound, are offered computed tomography (CT) of the abdomen and pelvis as the initial staging investigation.

Quality measure

Structure
Evidence of local arrangements and written clinical protocols to ensure women who are offered staging for ovarian cancer, following ultrasound, are offered CT of the abdomen and pelvis as the initial staging investigation.
Process
Process: Proportion of women who are offered staging for ovarian cancer, following ultrasound, who receive CT of the abdomen and pelvis as the initial staging investigation.
Numerator – the number of women in the denominator receiving CT of the abdomen and pelvis as the initial staging investigation.
Denominator – the number of women who are offered staging for ovarian cancer, following ultrasound.

Description of what the quality statement means for each audience

Service providers ensure systems and written clinical protocols are in place so that women who are offered staging for ovarian cancer, following ultrasound, are offered CT of the abdomen and pelvis as the initial staging investigation.
Healthcare professionals ensure women who are offered staging for ovarian cancer, following ultrasound, are offered CT of the abdomen and pelvis as the initial staging investigation.
Commissioners ensure they commission services that offer women who are offered staging for ovarian cancer, following ultrasound, a CT of the abdomen and pelvis as the initial staging investigation.
Women who are offered investigations to find out the stage of the ovarian cancer, following ultrasound, are offered a CT scan of the abdomen and pelvis as the first investigation.

Source clinical guideline references

NICE clinical guideline 122 recommendations 1.2.3.2 and 1.2.3.3.
The Royal College of Radiologists iRefer: Making the best use of clinical radiology: referral guidelines recommendation CA43 diagnosis (US).

Data source

Structure
Local data collection.
Process
National Cancer Outcomes and Services Dataset (in development), available from the National Cancer Intelligence Network.
Also contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): secondary care, criteria 5.

CT reporting

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women who have computed tomography (CT) for staging of ovarian cancer have the results reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.

Quality measure

Structure
Evidence of local arrangements and written clinical protocols to ensure that women who have CT for staging of ovarian cancer have the results reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Process
Proportion of women who have CT for staging ovarian cancer that have the results reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Numerator – the number of women in the denominator having their CT staging results reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Denominator – the number of women who have CT for staging of ovarian cancer.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women who have CT for staging of ovarian cancer to have it reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Healthcare professionals ensure women who have CT for staging of ovarian cancer have it reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Commissioners ensure they commission services in which CT for staging of ovarian cancer is reported by a radiologist who is a core member of the specialist gynaecological cancer multidisciplinary team.
Women who have a CT scan to find out the stage of the ovarian cancer, have the results reported by a radiologist who is a key member of the specialist gynaecological cancer multidisciplinary team.

Source clinical guideline references

TEG consensus.

Data source

Structure
Local data collection.
Process
Local data collection.

Definitions

A core member of the gynaecological cancer multidisciplinary team is one who attends (or, if unable to attend, is represented by a colleague who attends) at least two thirds of the multidisciplinary team meetings.
Specialist core members of a multidisciplinary team are described in the National Cancer Peer Review Programme's Manual for Cancer Services in gynaecology measure 11-2E-101.

Other imaging

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women with an indeterminate adnexal mass on ultrasound are offered magnetic resonance imaging (MRI) for further characterisation.

Quality measure

Structure
Evidence of local arrangements to ensure women with an indeterminate adnexal mass on ultrasound have MRI for further characterisation.
Process
Proportion of women with an indeterminate adnexal mass on ultrasound who have MRI for further characterisation.
Numerator – the number of women in the denominator who have MRI for further characterisation.
Denominator – the number of women with an indeterminate adnexal mass on ultrasound.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women with an indeterminate adnexal mass on ultrasound to have MRI for further characterisation.
Healthcare professionals ensure women with an indeterminate adnexal mass on ultrasound are offered MRI for further characterisation.
Commissioners ensure they commission services in which women with an indeterminate adnexal mass on ultrasound have MRI for further characterisation.
Women with a mass, growth or lump next to their womb, which usually arises from the ovary or fallopian tube, (called an adnexal mass), found by ultrasound, are offered an MRI scan to help find out if it is cancerous or non-cancerous.

Source clinical guideline references

The Royal College of Radiologists iRefer: Making the best use of clinical radiology: referral guidelines recommendations CA42 diagnosis (MRI) and CA43 staging (MRI).

Data source

Structure
Local data collection.
Process
National Cancer Outcomes and Services Dataset (in development), available from the National Cancer Intelligence Network.

Optimal surgical staging

This quality statement is taken from the ovarian cancer quality standard. The quality standard defines clinical best practice in ovarian cancer care and should be read in full.

Quality statement

Women with suspected stage I ovarian cancer have optimal surgical staging.

Quality measure

Structure
Evidence of local arrangements and written clinical protocols to ensure women with suspected stage I ovarian cancer have optimal surgical staging.
Process
a) Proportion of women with stage I ovarian cancer that had optimal surgical staging.
Numerator – the number of women in the denominator who had optimal surgical staging.
Denominator – the number of women with stage I ovarian cancer.
b) Proportion of women with stage I ovarian cancer that had up-front systematic retroperitoneal lymphadenectomy.
Numerator – the number of women in the denominator who had up-front systematic retroperitoneal lymphadenectomy.
Denominator – the number of women with stage I ovarian cancer.
Up-front systematic retroperitoneal lymphadenectomy is not recommended for women with stage I ovarian cancer therefore an audit standard of 0% should be expected in this process measure.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for women with suspected stage I ovarian cancer to have optimal surgical staging.
Healthcare professionals ensure women with suspected stage I ovarian cancer have optimal surgical staging.
Commissioners ensure they commission services in which women with suspected stage I ovarian cancer have optimal surgical staging.
Women with suspected stage I ovarian cancer (which is cancer that has not spread from the ovaries) have surgery (known as optimal surgical staging) that involves removing the cancerous tissue and making a full assessment of the stage of the cancer.

Source clinical guideline references

NICE clinical guideline 122 recommendations 1.3.1.2 and 1.3.2.1 (key priorities for implementation) and 1.3.1.1.

Data source

Structure
Local data collection.
Process
a) and b) National Cancer Outcomes and Services Dataset (in development), available from the National Cancer Intelligence Network.
Also contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): secondary care, criteria 9 and 10.

Definitions

Optimal surgical staging does not include up-front systematic retroperitoneal lymphadenectomy. NICE clinical guideline 122 states systematic retroperitoneal lymphadenectomy should not be included as part of standard surgical treatment for women who appear to have stage I disease.
NICE clinical guideline 122 defines the constituents of optimal surgical staging as: midline laparotomy to allow thorough assessment of the abdomen and pelvis; a total abdominal hysterectomy, bilateral salpingo-oophorectomy and infracolic omentectomy; biopsies of any peritoneal deposits; random biopsies of the pelvic and abdominal peritoneum; and retroperitoneal lymph node assessment.

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Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

alpha fetoprotein
beta human chorionic gonadotrophin
irritable bowel syndrome
multidisciplinary team
pegylated liposomal doxorubicin hydrochloride
Risk of malignancy index I
vascular endothelial growth factor

Paths in this pathway

Pathway created: February 2012 Last updated: April 2016

© NICE 2016

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