Gynaecological 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

REFERRAL GUIDELINES FOR SUSPECTED GYNAECOLOGICAL CANCER (All patients will be seen within 2 weeks of referral

  • Refer a patient who presents with symptoms suggestive of gynaecological cancer as detailed in the NICE guidance below.
  • Only refer when patient is available to attend an appointment within the next 14 days

Assessment

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
  • Vaginal discharge
  • Postmenopausal bleeding in patients unless patients is >60 -
    • Patients >60 with PMB will automatically be given a pelvic and speculum examination in Secondary Care.
  • 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 examination and pelvic examination, request Ca 125 levels, and consider referral for urgent TA/TV pelvic US examination.

In suspected cervical cancer, on examination, a smear test is not required before referral and a previous negative smear should not defer referral

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.

Please refer to:

IF PATIENT IS UNSURE WHERE BLOOD IS ORIGINATING, PLEASE PERFORM CLINICAL EXAMINATION TO CLARIFY WHETHER GYNAECOLOGY OR COLORECTAL PATHWAY MAY BE MORE APPROPRIATE

Referral

Referral Criteria

  • Symptoms
    • Postmenopausal bleeding (unexplained vaginal bleeding after ≥12 months amenorrhoea due to menopause)
  • Examination findings
    • Ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids)
    • Appearance of cervix consistent with cancer
    • Unexplained vulval lesion (vulval lump, ulceration or bleeding)
    • Unexplained palpable vaginal mass
  • The Referral recommendations on ovarian cancer have been incorporated from the NICE guideline on ovarian cancer (NICE guideline CG122, 2011) and have not been updated. The recommendations for ovarian cancer apply to women aged 18 and over
  • The risk of endometrial cancer for each arm of the pathway, as indicated in appropriate boxes on the referral form, is based on local audit of 1400 patients with PMB (Kremer et al 2010)

Referral Instructions


Supporting Information

 Assurance & Governance​

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA4 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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