Pathway Guide Ovarian cysts General Information Saint Marys Lead Dr Ursula Winters amp Dr Rohit Arora v10 Created 030221 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 re ID: 920380
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Slide1
Pathway Guide – Ovarian Cyst Management
Pathway Guide – Ovarian cysts: General Information| Saint Mary’s Lead: Dr Ursula Winters & Dr Rohit Arora | v1.0 | Created: 03/02/21
Knowing the optionsWhen 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)
Malignant / Suspicious Features
Unilocular cysts
Multilocular cysts
Diameter <10cm
Diameter >10cm
Minimal solid component <7cm
Solid component >7cm
Smooth outline
Irregular outline
Acoustic shadowing indicating Dermoid
Features not indicative of Dermoid
No blood flow
Prominent blood flow
No / Little fluid
Ascites or significant fluid
Slide2Pathway Guide – Ovarian cysts: Pre-menopausal
Pathway Guide – Ovarian cysts: Pre-menopausal| Saint Mary’s Leads:
Dr Ursula Winters and Dr Richard Clayton | v1.0 | Created: 03/02/21National GuidanceRCOG
Patient Information
NHS Website
Referral Proforma
2WW where appropriate
Endometrioma/ dermoid cyst
Suspicious features
Complex cyst
>7cm
>5cm
Request Ca 125 + Refer Suspected
Gynaecological
Cancer
<5cm likely functional
Simple cyst:
Reassure
5-7cm
Repeat scan at 3 months
Refer to Gynaecology
<5cm
Repeat scan at 3 months
Persistent and 3-5cm
Resolved
Reassure
2-week Suspected Cancer referral criteria: REFER SUSPECTED GYNAECOLOGICAL CANCER
-Abnormal abdominal/pelvic ultrasound suggestive of ovarian cancer
CA125 <35
CA125 >35
Refer to Gynaecology
Slide3Pathway Guide – Ovarian cysts: Post-menopausal
Pathway Guide – Ovarian cysts: Post-menopausal| Saint Mary’s Leads: Dr Ursula Winters and Dr Richard Clayton | v1.0 | Created: 03/02/21
National GuidanceRCOG
Patient Information
NHS Website
Referral Proforma
2WW where appropriate
Ca125 <35
Repeat USS in 4 months
Complex, multi-locular, separate solid component. Do Ca125
Ca125 >35
Ca125 >35
Refer via 2-week wait cancer pathway
<5cm
Simple, unilocular, no solid components
<5cm
>5cm
Ca125 <35
Refer to Gynaecology
Reassure
>5cm