When should you refer patients to a gynecologic oncologist?

Although several studies have shown that patients with ovarian cancer fare better if they receive specialized care, many of these women are not being referred to a gynecologic oncologist. A recent chart review of over 1,000 patients with pelvic masses strongly suggests that when clinicians follow the expert referral guidelines issued by the Society of Gynecologic Oncologists and ACOG, patients are definitely the winners.

The SGO/ACOG guidelines for referring women with pelvic masses rely on 5 parameters: a patient's age, CA-125 levels, physical findings, imaging study results, and family history. When these signposts were used retrospectively to distinguish benign from malignant tumors, investigators found that universal application of the guidelines would have resulted in 70% of premenopausal women and 94% of postmenopausal women being referred to a specialist because they had ovarian cancer.

For women under age 50, SGO/ACOG recommend that ascites, evidence of abdominal or distant metastasis, family history of breast or ovarian cancer in a first-degree relative, and a CA-125 reading above 200 U/mL be used as the basis for referring to a specialist. In women 50 or older, the criteria are CA-125 above 35, ascites, a nodular or fixed pelvic mass, evidence of abdominal or distant metastasis, and the same family history.

Im SS, Gordon AN, Buttin BM, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol. 2005;105:35-41.