When to Refer Patients to a Gynecologic Oncologist

Pelvic/Ovarian Masses

• Suspicious Pelvic Masses:
  • Size >10cm
  • “complex” features- irregularity, multiple septations, papillations or projections into the cyst, solid areas.
    • The risk of malignancy in a postmenopausal woman with a unilocular mass without solid components is <1% increasing to 8% in a multilocular mass and 70% in a mass with solid components.
  • Bilateral masses
  • “fixed” immovable masses
• Elevated tumor markers (CA125)
  
  • Elevations between 35 and 65 U/ml are associated with a cancer risk of 50 to 60%. A CA-125 >65 U/ml in a 50-year-old or older woman is virtually diagnostic of malignancy with a specificity of 98%.
• Family or personal history of breast or ovarian cancer
  
• Evidence of Advanced Disease- ascites (fluid), omental cake (large tumor mass in the omentum), gross evidence of metastatic tumor.
• Premenarchal (prior to first menstrual cycle) girls with a pelvic mass
  
• Young patients with pelvic mass and elevated tumor marker (CA125, AFP, hCG, LDH)