Referral of women with a pelvic mass to a gynecologic oncologist: ACOG guidelines

Premenopausal women (refer if any are present)

Very elevated CA 125 level*

Ascites

Evidence of abdominal or distant metastases

Postmenopausal women (refer if any are present)

Elevated CA 125 level*

Ascites

Nodular or fixed pelvic mass

Evidence of abdominal or distant metastases

ACOG: American College of Obstetricians and Gynecologists; CA 125: cancer antigen 125.

* These guidelines do not provide a specific value for an elevated (or very elevated) CA 125 level. While the 2002 version used a value of >200 units/mL, this was removed in 2011. Studies evaluating the performance of the 2002 guidelines showed that 70 to 79% of premenopausal and 93 to 94% of postmenopausal patients with ovarian cancer will be captured by this threshold (specificity 70 and 60%, respectively).

References:

American College of Obstetricians and Gynecologists. Cancer Diagnosis and Management. In: Guidelines for Women's Health Care, 4th ed, 2014.
Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117:742.
Im SS, Gordon AN, Buttin BM, et al. Validation of referral guidelines for women with pelvic masses. Obstet Gynecol 2005; 105:35.
Dearking AC, Aletti GD, McGree ME, et al. How relevant are ACOG and SGO guidelines for referral of adnexal mass? Obstet Gynecol 2007; 110:841.

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Referral of women with a pelvic mass to a gynecologic oncologist: ACOG guidelines