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Mount Vernon
Cancer Network
URGENT TWO WEEK REFERRAL. SUSPECTED GYNAECOLOGICAL CANCER
This form to be used only if the patient fulfils the following criteria.
If patient does not fulfil these criteria please make urgent or routine referral. Please see guidance attached.
PATIENT DETAILS
Surname
GP DETAILS
Title
Forename (s)
Name
Practice Code
DOB
Age
Telephone
NHS Number
UBRN
Fax
Address
Postcode
Practice name/address
Telephone
Home
Postcode
Work
Translator required
Mobile
Specify language
Confirm that the patient has been given a 2-week wait referral information leaflet.
Confirm that the patient understands that this is a referral to rule out suspected cancer.
Confirm that the patient is willing and able to attend in the next 2 weeks.
OVARIAN Ca.
Suspicious Pelvic mass on ultrasound (please see notes overleaf)
Palpable pelvic mass – not obviously fibroid, GI or renal tract tumour
Suspicion of ovarian cancer based upon otherwise unexplained combination of:
gastrointestinal or abdominal symptoms, ascites, raised CA125 or family history
ENDOMETRIAL Ca.
PMB and
Either
Or
Or
Or
not on HRT
persistent/unexplained after 6 weeks of cessation of HRT
Duration
weeks
persistent/unexplained bleeding on HRT
taking Tamoxifen
Chaotic and suspicious vaginal bleeding over 45 years
Intermenstrual or irregular bleeding not attributable to IUCD, polyp or hormones
CERVICAL Ca.
Suspicious lesion on cervix or
vagina
Postcoital bleeding lasting >4 weeks AND negative Chlamydia test
VULVAL Ca.
Exophytic vulval tumour
Vulval ulceration
Unexplained vulval bleeding
Additional information / other reasons for requesting urgent referral.
other primary cancer, specify site.
Please attach (if appropriate) printout of PMH, drugs and any other relevant information.
FAX East & North Herts NHS Trust: 01438 284503
If you have not received acknowledgement within 48hrs (Mon-Fri) please telephone 2/52 Wait Supervisor on
01438 285206.
FAX West Herts Hospitals Trust: 01727 897492
FAX Luton & Dunstable NHS Foundation Trust: 01582 497910 or 497911
FOR HOSPITAL USE ONLY
Date referral received:
1st appt date:
If 1st appt not accepted give reason/s:
2nd appt date
MVCN Gynae NSSG agreed September 2010, updated April 2013
Mount Vernon
Network
Guidance on Referral Criteria
Cancer
Only 8.4% of 14 day gynae referrals in the MVCN have a cancer final diagnosis
Half of gynae cancers in the network are referred through other pathways
We hope this guidance will be useful to primary care practitioners. It is intended to
make best use of the resources available to see women quickly, to protect primary
care practitioners and patients from delayed diagnosis and to reduce unnecessary
anxiety to women. They and the referral criteria will be subject to annual review and
responsive to further analysis of referral patterns and sources of diagnosis as well as
feedback received from primary care and patients.
Ovarian cancer
Postmenopausal
1. Unilocular ovarian cysts (no septations or solid areas) are likely to be benign
and can be referred non urgently providing CA125 is not elevated
2. All other ovarian masses on USS or pelvic masses should be referred under
14 days
3. New diagnosis of IBS (recent change) is unusual in women over the age of 50
Premenopausal
1. Raised CA125 is not diagnostic of ovarian cancer and many diagnoses can
elevate CA125 through peritoneal inflammation. Causes include cyclical
change, endometriosis, haemorrhagic or follicular/luteal cysts and infection.
2. “Complex” masses are frequently luteal, dermoid or endometrioma
3. Women should be referred under 14 days only if the imaging is sufficiently
suspicious
4. Advice from USS reports should be clear stating “Cancer Alert”
5. “Significant Abnormality” alerts should not automatically be referred under 14
Days
Endometrial Cancer
Pelvic examination must be performed to exclude cervical cancer
Postmenopausal
1. All cases of postmenopausal bleeding need to be investigated
2. Only 10-15% have malignant cause with 80-85% caused by atrophic
endometrium
3. Pelvic ultrasound (TVS) with endometrial thickness (ETT) <5mm is reassuring
in non-recurrent bleeding.
4. Women with persistent bleeding or abnormal ETT need biopsy
Premenopausal
1. USS reports measuring endometrial thickness will advise appropriate referral
2. About 20% of endometrial cancers are diagnosed under 55 years
3. Algorithms to refer “at risk women” are difficult to develop or validate but
delayed diagnosis does not seem to be a major problem in premenopausal
women.
4. Sudden, recent and significantly abnormal bleeding patterns merit 14 day
referral
5. Late onset menorrhagia is not in itself a reason for 14 day referral
Cervical Cancer
1. Women with ?invasive smear will have 2 week direct referral to colposcopy
2. Women with postcoital bleeding should be screened for chlamydia and have
cervical smear if they do not have an in date smear
Vulval Cancer
1. Most vulval cancers are obvious with raised or ulcerated tumour
2. Non-infectious vulval ulceration is regarded as malignant until proven
otherwise
3. Smooth vulval lumps deep to the vulval skin do not suggest cancer and should be
referred routinely, or urgently if recent growth raises suspicion
MVCN Gynae NSSG agreed September 2010, updated April 2013
Urgent “2 week wait” referral to Hospital
Why have I been referred to the hospital?
Your General Practitioner (GP) or Dentist has
asked for an urgent hospital appointment for
you, because you have symptoms that might
indicate cancer.
Does this mean I have cancer?
After the examination, we find that most
patients who come to us do not have cancer,
but another condition.
Let your GP surgery know if you have not
heard from the hospital a week after you
have seen your GP.
So why has my GP referred me?
If you are unable to attend the appointment
sent to you, please phone the hospital
immediately. It is important that you arrange
another date and time if you have to cancel
an appointment.
There could be several reasons why your
doctor has sent you for a special test, for
instance,


you are likely to be away, or unable to attend
hospital for any reason, within two weeks
after you have seen your GP.
The hospital will send you an appointment
letter within a week; if there is not sufficient
time to send you a letter they will contact you
by phone.
GP’s can diagnose and treat most complaints
and illnesses themselves. However, on some
occasions they need to arrange for you to
have a hospital assessment, so that you can
see a specialist hospital doctor. The “two
week wait” appointment system was
introduced so that you can have
investigations done and be seen as quickly
as possible.


Mount Vernon
Cancer Network
Your Hospital Appointment
At your first appointment, based on the
information from your GP and your
consultation with the hospital doctor, the
clinic staff will give you more information
about what will happen next.
Please feel free to bring someone with
you to your appointment.
Your symptoms need further investigation
The treatment already prescribed has not
worked
Investigations your GP arranged have shown
some abnormal results
To make sure you don’t have a serious
disease.
If you have any queries regarding the
arrangements for your appointment,
please telephone the hospital you have
been referred to on one of the numbers
below Monday to Friday 8.30am - 5.00pm
Will I need any tests?
East & North Herts NHS Trust:
Two-week-wait office: 01438 285206
You may require specialised tests and these
tests may take place either before your first
appointment with the specialist hospital
doctor, or during it. This will help the doctor to
understand the cause of your symptoms.
West Herts Hospitals Trust:
Two-week-wait office: 01727 897199
Luton & Dunstable Hospital Trust
Outpatient Appointment line: 0845 1270193
What do I need to do now?
Make sure that your GP has your correct
address and telephone number, including
mobile number, if possible.
It is very important that you are available to
attend an appointment within two weeks of
seeing your GP. Please tell your GP if you if
Produced March 2011, updated April 2013
Further Information
NHS Choices (Guide to waiting times)
www.nhs.uk/
1.1
NICE (Clinical Guidelines, Referral for
Suspected Cancer) www.nice.org.uk