Gynaecology 2WW

Scope

GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.

Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.

Refer a patient who presents with symptoms suggesting gynaecological cancer to a team specialising in the management of gynaecological cancer, depending on local arrangements.

Investigations

A full pelvic examination, including speculum examination of the cervix, is recommended for patients presenting with any of the following:

alterations in the menstrual cycle
intermenstrual bleeding
postcoital bleeding
postmenopausal bleeding
vaginal discharge

Ovarian cancer is difficult to diagnose. In patients with vague, non-specific, unexplained abdominal symptoms such as:

bloating
constipation
abdominal pain
back pain
urinary symptoms
carry out an abdominal palpation. Also consider a pelvic examination.

In patients with vulval pruritus or pain, a period of 'treat, watch and wait' is reasonable. Active follow-up is recommended until symptoms resolve or a diagnosis is confirmed. If symptoms persist, the referral may be urgent or non-urgent, depending on the symptoms and the degree of concern about cancer.

Consider pelvic USS/Ca 125 and FBC where appropriate.

Referral

Referral Criteria

Supected gynaecological cancer referral criteria

1. Ovarian cancer (include Ca125) – Physical examination identifies ascites and/or a pelvic or abdominal mass (not obviously fibroids)

2. Endometrial cancer – Refer patients aged 55 and over with post-menopausal bleeding (unexplained vaginal bleeding of more than 12 months after menstruation has stopped because of the menopause)

Consider referral if aged under 55 with post-menopausal bleeding
If patient is on HRT – cease it for 6 weeks to evaluate bleeding maybe helpful when considering referral

3. Cervical cancer – when the appearance on cervical examination is consistent with cervical cancer

4. Vulval cancer – unexplained vulval lump, ulceration or bleeding

5. Vaginal cancer – unexplained palpable mass in or at the entrance of the vagina

A recent FBC would be useful