QuestionSBA
QuestionChoice
Whilst it would be important to investigate the possibility of Coeliac disease if the CA-125 was normal, Ovarian cancer should be ruled out urgently before investigating other differentials of these symptoms.
10035815
d
Arrange IgA TTG and total IgA antibody testing
QuestionChoice
These symptoms in a woman >50 years old are concerning for ovarian cancer. NICE recommends measuring a serum CA-125 if an abdominal examination is normal. If the abdominal examination was abnormal, an urgent 2-week wait referral should be carried out.
10035812
a
Measure serum CA-125
QuestionChoice
Whilst early satiety and bloating can be associated with gastroparesis which is strongly linked to diabetes mellitus, the fluctuating diarrhoea and constipation, in conjunction with weight loss are more concerning for ovarian cancer.
10035816
e
Arrange HbA1c testing
QuestionChoice
This should only be done once the CA-125 is found to be raised. If the initial abdominal examination is abnormal an urgent 2-week wait referral should be carried out.
10035813
b
Arrange an urgent ultrasound of the abdomen and pelvis
QuestionChoice
Whilst fluctuating diarrhoea and constipation in conjunction with bloating can be seen in IBS, it is vital to rule out any other conditions before this is diagnosed. Specifically, any post-menopausal female with IBS-like symptoms should raise suspicion of ovarian cancer
10035814
c
No investigation is required, advise following a low FODMAP diet
Concept
Chapter
2693
6151
Ovarian cancer
Topic
225
Oncology and Palliative Care
19566
In women over 50 with unexplained abdominal symptoms, measuring serum CA-125 is essential for evaluating potential ovarian cancer.
A 65-year-old female has a 6-month history of feeling bloated after meals. She has lost 6kg in this period due to decreased appetite and has also experienced fluctuating diarrhoea and constipation. She has a past medical history of hypercholesterolaemia and has two children, born via uncomplicated vaginal delivery. Her last menstrual period was 10 years ago.

On examination, her abdomen is soft and non-tender, with no evidence of obvious distension, ascites or any palpable masses.

What is the most appropriate initial investigation?
a