Cancer Type Suspected

Vagina/Vulva

  • Unexplained vulval lump
  • Vulval ulceration
  • Vulval bleeding
  • Unexplained palpable mass in vagina

Cervix

  • Appearance of cervix on examination consistent with cervical cancer

Endometrium

  • Post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause)
    • CRH refer on ICE to PMB pathway

Ovary

  • Physical examination reveals ascites
  • Physical examination reveals pelvic mass – not obviously fibroids (undertake Ultrasound in Primary Care to check)
  • Ultrasound suggests ovarian cancer following revised CA125 test

Menopausal Status

  • Pre-Menopausal
  • Post-Menopausal (> 1 year since LMP)
  • Hysterectomy
  • On HRT
  • Perimenopausal

UNEXPLAINED PERSISTANT SPLENOMEGALY – without evidence of chronic liver disease: Please provide details in the referral form.

Cancer Less Likely
  • PCB with a normal cervix– refer colposcopy (see PCB guidelines) 
  • Unscheduled bleeding on HRT is not a 2WW criteria and the risk of cancer is very low. Ideally stop HRT and refer as a 2WW if still bleeding six weeks after cessation of therapy. If patients are very unkeen to stop HRT then please refer on Choose & Book.
  • Women with IMB (intermenstrual bleeding) where a speculum examination has excluded cancer of vulva, vagina and cervix. Refer routinely on Choose & Book to menstrual disorder/general gynaecology clinic

Significant Weight Loss Only?

Non Site-Specific Pathway

Additional GP Guidance
  • Significant risk factors include; Obesity, Lynch syndrome, Tamoxifen usage.
  • In women with PMB the probability of endometrial cancer in women presenting with PMB is 5–10%.
  • Women with menorrhagia over 45 years, or those with irregular bleeding or failure of treatment over 45 also need endometrial sampling.
  • In women with an ET <5mm on transvaginal ultrasound they can have clinical (abdominal and speculum) examination and discharged is no abnormality is seen however if bleeding is recurrent they need referral under a 2WW pathway.
  • If an incidental thickened endometrium of ≥10mm is detected in a post menopausal women who has not had any PMB they should be referred in for endometrial sampling.
  • Incidental thickened endometrium of <10mm in a post menopausal women who had not had any PMB required no action.
  • Investigate new onset Irritable bowel symptoms in women aged over 50 with Ca125 and USS.