Referral

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Gynaecology

Key Messages

GPs can refer a patient they suspect of having cancer for rapid assessment. Suspected cancer pathways are now measured against the ‘Faster Diagnosis Standard’ (FDS), in which the patient is expected to be given a diagnosis within 28 days.

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 Alliance.

Unscheduled bleeding on HRT is very rarely (1-1.5%) associated with cancer.

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A full pelvic examination, including speculum examination of the cervix, is an important part of the required assessment 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. Carry out an abdominal palpation and consider pelvic examination where appropriate in patients with vague, non-specific, unexplained abdominal symptoms such as:

  • bloating
  • constipation
  • abdominal pain
  • back pain
  • urinary symptoms

If considering referral for possible ovarian cancer, please include the following blood tests:

  • CA125, FBC, Ferritin, LFT, Renal, and if under the age of 40 please also include LDH, B-HCG and aFP.

Please note that CA125 may be elevated if taken during menstruation. Consider repeating the test if this is the case.

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.

Referral Criteria

Ovarian cancer

a. Physical examination identifies ascites and/or a pelvic or abdominal mass (not obviously fibroids)
b. Abdominal symptoms and an elevated CA125

Please include CA125, FBC, Ferritin, LFT, Renal, and if under the age of 40 please also include LDH, B-HCG and aFP.

Endometrial cancer

Not taking HRT:
a. women with an intact uterus with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause)

Taking HRT - unscheduled bleeding with concern of endometrial cancer:
a. Unscheduled bleeding in a postmenopausal woman persisting for more than 6 months after starting HRT
b. Unscheduled bleeding in a postmenopausal woman persisting for more than 6 months after a change in HRT
c. Bleeding persisting more than 4 weeks after stopping HRT
d. Unscheduled bleeding in women on HRT with a family history of endometrial hyperplasia, endometrial cancer, Lynch Syndrome or Cowden syndrome, or in women with a BMI of over 40.
e. Endometrial thickness of greater than 4mm on continuous combined HRT
f. Endometrial thickness of greater than 7mm on sequential combined HRT
g. Other unscheduled bleeding on HRT with GP cancer concern (outside of guidelines)

Please consider coil removal (affects endometrial thickness measurements) and an up-to-date FBC prior to referral

Cervical cancer
Appearance on cervical examination is consistent with cervical cancer

Vulval cancer
Unexplained vulval lump, ulceration or bleeding that is suspicious for malignancy

Vaginal cancer
Unexplained palpable mass in or at the entrance of the vagina that is suspicious for malignancy

Referral instructions

The GP should: use e-Referral Service to book an appointment or send the referral.

Please ensure you include:

  • The patient's NHS number
  • Tell the patient that this is an urgent referral and should be safety netted appropriately

e-Referral selection:

  • Specialty: 2WW
  • Clinic Type: 2WW Gynaecology
  • Service selection: Two Week Wait Gynaecology-RDE-RH8 / Two Week Wait Post-Menopausal Bleeding-Gynaecology Department-RDE-RH8

Please ensure that referrals are booked via NHS e-Referral Service. If no slots are available please defer to provider and the RDUH will book the appointment and contact the patient. Please also ensure that referral letters are attached to the system within 24 hours to enable us to book pre appointment tests and scans timely.

Referral Form

Suspected Gynaecological cancer referral form - No merge fields

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