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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