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Ovarian cyst / pelvic mass

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Acute urinary obstruction
  • Unstable molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology

 

  • Refer to local Healthpathways or local guidelines
  • ROMA score in premenopausal women with elevated CA125 would be beneficial to have at the time of the referral.  However, this may incur an out-of-pocket cost to the patient.
  • If cyst simple or haemorrhagic corpus luteal cyst and <5 cm repeat scan in 6 – 12 weeks
  • If recurrent cysts, consider COCP or Implanon®

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Suspicious of malignancy or high risk features:
      • USS findings such as solid areas, papillary projections, septations, abnormal blood flow, bilaterally or ascites
      • ovarian cyst >12cm
      • elevated CA125 and cyst >5cm in premenopausal patients or any size cyst in post-menopausal patient
    • Consider if significant pain and/or due to risk of torsion
    • Pre-pubertal patient
  • Category 2
    (appointment within 90 calendar days)
    • Persistent ovarian cyst >5cm on 2 pelvic USS 6 weeks apart
    • Complex cyst (haemorrhagic, endometriotic or dermoid)
    • Persistent pelvic pain
  • Category 3
    (appointment within 365 calendar days)
    •  Hydrosalpinx

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History including pain and other symptoms
  • CA125 results
  • Pelvic USS (TVS preferable)

3. Additional referral information Useful for processing the referral

  • Family history of breast and ovarian cancer
  • ROMA score in premenopausal women with elevated CA125
  • In paediatric and adolescent patients, remember to exclude germ cell tumours with markers: alpha feto protein LDH BHCG along with the other tumour markers

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access  mandatory tests or investigations as they incur a cost or are unavailable locally.