Gynaecological cancers
Endometrial
Vulval
Referral times
Ovarian
Ix- CA125 will be is 35 IU/ml or greater. Refer for transvaginal ultrasound
Diagnosis- biopsy
Symptoms include abdominal pain, abnormal vaginal bleeding, loss of weight, loss of appetite and fatigue.Urinary urgency and frequency, esp in over 50s. IBS in past 12 months, and over 50. Change in bowel habit. The Cancer may also present with abdominal distension
symptoms include Any woman on HRT, presenting with persistent or unexplained postmenopausal bleeding, after cessation of HRT for 4 weeks. Unscheduled vaginal bleeding in a patient taking tamoxifen. Postmenopausal bleeding. Persistent intermenstrual bleeding, especially with other risk factors despite a normal pelvic examination. Abdominal/pelvic mass that is not fibroids/GI, urgent same day referral for U/S
Ix - ultrasound
Diagnosis- endometrial biopsy
Cervical
Ix
Diagnosis- biopsy
Symptoms- Any woman with clinical features (vaginal discharge, postmenopausal, postcoital or persistent intermenstrual bleeding) and abnormality suggestive of cervical cancer on examination of the cervix
Ix- cancer pathway
Diagnosis- biopsy
Symptoms- Any unexplained vulval lump on examination
Vulval bleeding due to ulceration
Vaginal
Ix- cancer pathway
Diagnosis- biopsy
Symptoms- Any suspicious abnormality of the vagina on speculum examination. Mass, unexplained, palpable, in or at entrance to vagina
Immediate: an acute admission or referral occurring within a few hours, or even more quickly if necessary.
Urgent: the patient is seen within the national target for urgent referrals (currently 2 weeks).
Very urgent: to happen within 48 hours.
Non-urgent: all other referrals
Patient information and support
References
Advice re investigations, referral process, length of time to wait for review, suspected diagnosis. Provide information, if patient wishes.
Safety netting if appointment does not arrive within a timescale, any concerns or worries they wish to discuss etc