Tubal and Ovarian Cancer

Availability

North South North West Statewide

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.

Urgent / category 1

Ovarian cancer

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

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

We will endeavour to see urgent referrals for women with a suspected or proven gynaecologic malignancy within one to two weeks.  If you have any trouble obtaining an urgent appointment please contact our secretary on (03) 6166 8049.

Semi-urgent:

Women will be given an appointment between one to eight weeks depending upon reason for referral

Routine: