Download URGENT TWO WEEK REFERRAL

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 Surname
GP DETAILS
Title Title
Forename (s) Given Name
DOB Date of Birth
Name Current User
Practice Code
Age Age
Telephone
NHS Number NHS Number
UBRN Referral UBRN
Fax
Address Home Full Address (single line)
Practice name/address
Telephone
Home Patient Home Telephone
Postcode
Work Patient Work Telephone
Translator required
Mobile Patient Mobile Telephone
Specify language Main 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
Unexplained vulval bleeding
Vulval ulceration
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:
MVCN
Gynae
NSSG
agreed
September
2010, updated April 2013
2nd appt date
Mount Vernon
Cancer Network
Guidance on Referral Criteria
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
MVCN Gynae NSSG agreed September 2010, updated April 2013
Mount Vernon
Cancer Network
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.
So why has my GP referred me?
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.
There could be several reasons why your
doctor has sent you for a special test, for
instance,
 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.
Will I need any tests?
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.
What do I need to do now?
Mount Vernon
Cancer Network
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
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.
Let your GP surgery know if you have not
heard from the hospital a week after you
have seen your GP.
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.
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.
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
East & North Herts NHS Trust:
Two-week-wait office: 01438 285206
West Herts Hospitals Trust:
Two-week-wait office: 01727 897199
Luton & Dunstable Hospital Trust
Outpatient Appointment line: 0845 1270193
Produced March 2011, updated April 2013
Mount Vernon
Cancer Network
Further Information
NHS Choices (Guide to waiting times)
www.nhs.uk/
NICE (Clinical Guidelines, Referral for
Suspected Cancer) www.nice.org.uk
Produced March 2011, updated April 2013