Reviewed on : 4 Apr 2016

Reviewed by : Manjari Bollu, GP Gateway Editor

Expires : 4 Apr 2018

TWO WEEK REFERRAL SERVICES – GYNAECOLOGY – ARDEN CANCER NETWORK

OVARIAN CANCER

Examination identifies ascites and/or abdominal mass (not obvious/known uterine fibroids)
OR
Women (especially over 50) with > 12 times per month:

• Persistent abdominal distension/bloating
• Early satiety / loss of appetite
• Pelvic or abdominal pain
• Increased urinary urgency and/or frequency
• Symptoms suggestive of IBS

AND Ca125 > 35 IU/ml

Imaging is organised more quickly and appropriately from secondary care

Please DO NOT request USS/CT/MRI before referral 

ENDOMETRIAL CANCER*

•  Post-menopausal bleeding: Vaginal bleeding > 12 months after cessation of menstruation
•  Unscheduled bleeding ≥ 3months after commencing HRT
•  Vaginal bleeding on tamoxifen

A uterus must be present (i.e.no previous hysterectomy)    Ca125 is NOT indicated 

An USS will be organised in secondary care, DO NOT request  in primary care

CERVICAL CANCER**

The appearance of the cervix on speculum examination is consistent with cervical cancer

Ca125 and USS are NOT indicated in suspected cervical cancer

VAGINAL CANCER

Women with an unexplained mass in or at the entrance to the vagina

Which is not obviously a vaginal or uterine prolapse

VULVAL CANCER

An unexplained vulval lump, ulcerated, bleeding or painful lesion

This pathway is for patients with clinical indications of a new malignancy in accordance with:

National Collaborating Centre for Cancer 2015 guidelines: https://www.nice.org.uk/guidance/ng12

Notes

*Endometrial Cancer

NICE (2015) Guidance suggests to consider requesting an USS for women >55 with

1. Unexplained symptoms of vaginal discharge:

• Who are presenting with these symptoms for the first time or
• have thrombocytosis or
• report haematuria, or

2. Visible haematuria and

• low haemoglobin levels or
• thrombocytosis or
• high blood glucose levels

**Cervical Cancer

Women with unexplained post-coital bleeding should be referred to a gynaecology clinic for assessment by a gynaecologist. If cervical cancer is suspected, they will be referred for colposcopy within 2 weeks.

All 2WW referrals should be made through the NHS eReferral Service (previously known as choose and book).