Outpatient Clinics

This condition is treated in the Gynaecologic Oncology clinic

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

• For known or strongly suspected tubal or ovarian cancer:
  • Women will either present with a pelvic or abdominal/pelvic mass or with suspected malignant ascites
• Women with a pelvic mass:
  • The risk of malignancy index (RMI) can be helpful in working out if women should be referred to a Gynaeoncologist or General Gynaecologist. It is a product of the ultrasound scan score (U), menopausal status (M) and serum CA125 level.  A woman with a pelvic mass and a RMI of 200 or more should be referred to a Gynaecologic Oncologist
    
    RMI I = U x M x CA125
    The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites, bilateral lesions
    U = 0 for an ultrasound score of 0 points
    U = 1 for an ultrasound score of 1 point
    U = 3 for an ultrasound score of 2–5 points
    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
    Serum CA125 is measured in IU/ml
• Women with new onset suspected malignant ascites:
  • Consider the diagnosis of malignant ascites when renal, liver and cardiac disease has been considered as a cause and eliminated.
• Women with tubal or ovarian malignancy presenting with ascites may or may not have a significant pelvic mass
• For women presenting with newly suspectedmalignant ascites possibly due to a gynaecological malignancy contact with the services Consultants via the Royal Hobart Hospital Switch or their Secretary (Phone: 6166 8049) will ensure prompt attention.  On occasion admission for prompt investigation is the optimal management

Tests

• Transvaginal ultrasound of pelvis
• CA125 level
• FBE, C&E. LFT
• CEA
• CT scan of abdomen, pelvis and chest can be helpful

Interim/GP management

To refer a patient with this condition, please see the Gynaecologic Oncology clinic page for the full referral process and templates.

Please phone the above phone numbers to contact the service promptly.

For more information please see the Tasmanian Health Pathways website.

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.