Indications for 'Early' Referral

Indications for 'early' referral (i.e. within 4 weeks):

  • Any other women with postmenopausal bleeding not on HRT
  • Repeated unexplained postcoital bleeding

N.B.  In women over 45 years with persistent abdominal pain or distension, ovarian cancer should be considered and a pelvic examination performed.

Communication with Primary Care

Where a patient is given a diagnosis of gynaecological cancer, the patient’s GP will be informed by the end of the next working day. The call is made to the GP practice and if unable to talk to the GP directly a message is left with the receptionist with contact details of the CNS in case there are questions. This policy applies to both In-Patients and Out-Patients.

Top tips in gynaecological cancer
  1. Early diagnosis leads to better treatment outcomes so have a low threshold for investigating or referring patients on whose symptoms cause you disquiet.
  2. Consider the possibility of missing a clinically obvious cancer before omitting a pelvic examination in a woman with gynaecological symptoms (e.g. the woman who does not stop bleeding for long enough to have her smear) especially if they are not being onwardly referred.
  3. Patients whose symptoms do not strictly fulfil the 2WW referral criteria are much less likely to have cancer (<1/20) and so can be referred on an early pathway instead (4-6 weeks).
  4. Almost half of patients mistakenly believe that a normal smear test rules out ovarian cancer.
  5. Ovarian cancer is not a silent killer and most women who present have had symptoms for many months.
  6. IBS type symptoms in a woman over 50 years of age should arouse suspicion of ovarian cancer.
  7. Change in bowel habit to less frequent/constipation in the absence of any other symptoms has the lowest positive predictive value of any 2WW criteria (between 1 in 30 and 1 in 50 turn out to have colorectal neoplasia).
  8. Women with new, persistent symptoms (which may include abdominal distension, persistent bloating, increased girth, abdominal pain and feeling fuller faster when eating small amounts) occurring more than 12 times a month should have a CA125 performed and an USS if it is abnormal.
  9. If patients in follow up after cancer treatment develop suspicious symptoms they should contact their Key Worker immediately for an urgent review and not wait for their next scheduled appointment.
  10. Links to resources, information about the local gynaecological oncology service, and educational events is available on our hospital website
2ww Patient Leaflet Ordering

If you would like to order copies of the GCCG 2WW Patient Leaflet, please contact the Cancer Clinical Programmes Team via reception on 0300 421 1500

Palliative Care - Top Tips - GHFT

Please follow the resource link below to the End of Life section for GHFT's top tips for palliative care.