Ovarian cancer

ADULT

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

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Malignant bowel obstruction
    • Febrile neutropenia
    • Refer to local HealthPathways or local guidelines
    • Women with suspected Ovarian cancer are usually evaluated initially by the Gynaecology-Oncology service and their cases discussed in a multidisciplinary team meeting. Some patients may be recommended treatments for these cancers such as chemotherapy as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the Gynae Oncology surgical service, not Medical Oncology.
    • Depending on the subtype of ovarian cancer, treatment options vary, for patients with newly diagnosed ovarian cancer, from surgery and adjuvant chemotherapy for early-stage and well differentiated disease, to systemic therapy with chemotherapy or other drug therapy as neoadjuvant or adjuvant treatment, or as a primary treatment modality. The treatment course is decided through the Gynaecology-Oncology Multidisciplinary tumour meeting.
    • Patients are often referred for Genetic counselling and testing following their diagnosis of some Ovarian cancer types (such as high grade serous ovarian cancer).
    • Serum tumour bio-markers such as CA125, CEA and, in some women, HCG, AFP, LDH may be used as part of the diagnostic evaluation.
    • For women who have not completed their family, fertility preservation needs to be discussed
    • For patients with incurable (metastatic or recurrent) cancer consider the following:
      • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the woman's prognosis and their understanding of their prognosis
      • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
      • specific patient goals and values that may impact on treatment choices
      • whether the patient has been referred to a palliative or supportive care service
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Patients with early stage or locally advanced Ovarian cancer should be referred to the Gynaecology-Oncology surgical team for evaluation and further investigation / staging. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input. For optimum care, patient should be seen within 2 weeks.

Patients presenting with uncomfortable and symptomatic ascites suspected of a new diagnosis of ovarian cancer may be referred through local Emergency department for immediate symptomatic management and further Specialist assessment for investigation and biopsy.

  • Patients requiring neoadjuvant chemotherapy as discussed in MDT (biopsy confirmed), for optimum care, patient should be seen within 2 weeks.
  • Patients requiring adjuvant chemotherapy following surgery, for optimum care, patient should be seen within 4 weeks.
    Patients requiring chemotherapy for advanced disease (biopsy confirmed) for optimum care, patient should be seen within 4 weeks.
Category 2
(appointment within 90 calendar days)
  • Previously treated patients with ovarian cancer requiring routine follow-up
  • Transfer of care from another health service
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

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

  • Family history
  • Previous cancer treatment details including location; dates; treating doctor; details of prior treatment regimes and imaging / pathology results.
  • Histology /cytology results – current +/- previous
  • Routine blood and tumour marker tests (CA125, CEA and, in younger women, HCG, AFP, LDH)
  • Pelvic ultrasound (preferably transvaginal)
  • Chest x-ray
  • Contrast-enhanced CT scan of the abdomen and pelvis

3. Additional referral information Useful for processing the referral

  • Any prior genetic testing results.
  • Other available imaging (PET/CT scan or MRI of the abdomen/pelvis).
  • Other investigations may be considered including fluid aspiration for cytology (pleural or peritoneal) and image-guided biopsy however these are usually performed following Gynaecology-Oncology assessment.
  • Patients with suspected diagnosis of ovarian cancer can be referred to the nearest Gynae-Oncology service for initial investigation and confirmation of diagnosis.

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.)

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

    • 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.

Last updated: 28 January 2025

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