Pathway Guide Ovarian cysts: General Information ...

Pathway Guide ? Ovarian cysts: General Information

Saint Mary's Managed Clinical Service Manchester University NHS Foundation Trust

Knowing the options When a scan report is received indicating an ovarian cyst, there are only three options for further management which are to repeat, to reassure, or to refer (either routine or urgent). Most scan reports will include management advice based on the following pathways. When reviewing a scan result, patients should be managed according to their fertility status: Pregnant, Pre-menopausal, and Post-menopausal.

Ultrasound features can be broadly divided into benign (reassuring) or malignant (suspicious) as shown in the table below:

Benign / More Reassuring Features (Simple)

Unilocular cysts Diameter 7mm Irregular outline Features not indicative of Dermoid Prominent blood flow Ascites or significant fluid

Pathway Guide ? Ovarian cysts: General Information| Saint Mary's Lead: Dr Ursula Winters & Dr Rohit Arora | v1.0 | Created: 18/03/20

Pathway Guide ? Ovarian cysts: Pregnancy

Saint Mary's Managed Clinical Service Manchester University NHS Foundation Trust

Ovarian cyst found on ultrasound arranged by GP

Simple or Endometrioma

4cm

GP to arrange for rescan in 4 weeks

&

GP to refer to EGU Scan clinic (for follow-up of results and management plan)

Malignant/suspicious features (see previous page)

GP request Ca125

2WW referral to Gynaecology

Patient Information NHS Website

Referral Proforma N/a

Local Guidance N/a

National Guidance RCOG

Pathway Guide ? Ovarian cysts: Pregnancy| Saint Mary's Lead: Dr Ursula Winters & Dr Rohit Arora | v1.0 | Created: 18/03/20

Pathway Guide ? Ovarian cysts: Pre-menopausal

If patient is in significant pain and concerns ? torsion contact on-call

Consultant Gynaecologist via switchboard: 0161 276 1234

Ovarian cyst found on ultrasound arranged by GP (cyst found on CT will require TVUS)

Saint Mary's Managed Clinical Service Manchester University NHS Foundation Trust

5cm simple cyst or any size haemorrhagic cyst asymptomatic

No further action or follow up, give reassurance

34 U/mL No

2WW referral to Gynaecology Yes

5cm

No action, Give reassurance

No change or

decreasing size

Arrange repeat Ultrasound Scan at 12 months

Increasing size

Repeat scan in 6 weeks, if unchanged or larger

Routine referral to gynaecology

Patient Information NHS Website

Referral Proforma N/a

Local Guidance N/a

National Guidance RCOG

Pathway Guide ? Ovarian cysts: Pre-menopausal | Saint Mary's Lead: Dr Ursula Winters & Dr Rohit Arora | v1.0 | Created: 18/03/20

Pathway Guide ? Ovarian cysts: Post-menopausal

Saint Mary's Managed Clinical Service Manchester University NHS Foundation Trust

Ovarian cyst found on ultrasound arranged by GP (cyst found on CT will require TVUS)

Simple

Malignant / suspicious features

1cm and 34 U/mL

No

2WW referral to Gynaecology

If resolved (or 34 U/mL or suspicious features

Cyst with any of the following features:

? symptomatic non simple features ? >5cm ? multilocular ? bilateral (as in the RCOG

guideline)

GP request Ca125

Yes Ca125 >34 U/mL

No

Urgent referral to gynaecology

If unchanged or smaller, and asymptomatic, no further action

If persistent / unchanged organise repeat Ca125 + scan at

6m (total fu = 1 yr)

Size increasing

Refer to gynaecology

Patient Information NHS Website

Referral Proforma N/a

Local Guidance N/a

National Guidance RCOG

Pathway Guide ? Ovarian cysts: Post-menopausal| Saint Mary's Lead: Dr Richard Clayton | v1.0 | Created: 18/03/20

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