HNY Policy and Pathway Repository - York

• Ultrasound scan is initial investigation of choice – transabdominal and possibly transvaginal
• Radiology will give guidance on further management but assess the patient clinically and continue to investigate if concerned
• Radiology department at YHFT has a complicated algorithm (depending on size and features of cyst) and will offer guidance about management. If a referral to Gynaecology is recommended, then a CA125 should be considered

• Abdominal/vaginal mass, thought to be ovarian, will need urgent USS and CA125 or 2WW referral
• Raised CA125

Will be guided by radiology report of USS or CT/MRI
 

Indications for referral

• As guided by scan report
• Consider admission for a woman presenting with any ovarian torsion symptoms with a known ovarian cyst via Gynae registrar on-call
   

Examination Findings

Abdominal and vaginal examination – good clinical practice
 

Investigations prior to referral 

• SS and CA125

Information to include in referral letter

• Symptoms and timescale
• Current contraception / hormone therapy
• Abdominal/vaginal findings
• Smear history
• USS result
• CA125
• Relevant past medical / surgical history
• Current regular medication
• BMI
• Smoking status

Patient information

Ovarian cysts before the menopause
 

References:

1. Levine D et al. Management of Asymptomatic Ovarian and other Adnexal Cysts imaged at US; Society of Radiologist in Ultrasound Consensus Conference Statement. Radiology 2010; 256; 943-954
    
2. Sauders B et al. Risk of malignancy in sonographically confirmed septated cystic ovarian tumours. Gynaecologic Oncology 2010 – 118; 278-282
    
3. Greenlee R et al. Prevalence, incidence and natural history of simple ovarian cysts among women >55yrs old in a large cancer screen trial. American Journal of Obstetrics and Gynaecology 2010 ; 202-373 e 1-9
    
4. Ovarian cysts in Postmenopausal Women. Royal College of Obstetricians and Gynaecologists 2003 Guideline No 34
    
5. Ovarian masses in premenopausal women RCOG 20011 Green top Guideline 62