Ovarian Cancer

Emergency department referrals

Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.

Contact on call Oncology Registrar through:

Royal Brisbane & Women’s Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

View the emergency contact details for referring General Practitioners.

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

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

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

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 days is desirable

Previously treated patients with ovarian cancer requiring routine follow-up
Transfer of care from another health service

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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

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.

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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