Ovarian Enlargement: Management

Question 1

What is the imaging modality of choice for ovarian cysts/tumours?

Answer 1

USS

Question 2

The USS report will usually say, simple or complex, what does this mean?

Which is more likely to be malignant?

Answer 2

Simple = unilocular and more likely to be benign.

Complex = multilocular and more likely to be malignant

Question 3

How do you manage Ovarian cysts in Post-menopausal women?

(According to Miss Sule and Mukhpadyay at NNUH)

Answer 3

• <1cm & described as Simple & Normal Ca125 - no further action.
• >1cm + Malignant Features OR Raised CA125 - 2WW Referral
• 1-5cm + Benign Features & Normal Ca125 = Routine Referral.
• >5cm - 2WW Referral

Question 4

How do you manage Ovarian cysts in Pre-menopausal women?

(According to Miss Sule and Mukhpadyay at NNUH)

Answer 4

• <5cm - likely functional/benign and no further action. Refer if symptomatic.
• 5-7cm + Benign features + Normal CA125 - Routine Referral
  
  • These are often rescanned every 3- 4 months to see if resolution.
• >7cm + Simple or Dermoid or Endometrioma
• >7cm + Raised CA125 - 2WW Referral
• Malignant features (especially if raised CA125) - 2WW Referral

NOTE 1 = Malignant Features = Complex, Solid, Multilocular or Bilateral

NOTE 2 = Endometrioma = Endometrosis of the Ovaries. A.K.A. Chocolate cysts.

Note 3 = Dermoid cysts usually don’t resolve and gradually get bigger.