Gynaecological Cancers: Guidelines for Urgent Referral

Urgent Referral

• Lesion suspicious of cancer on cervix or vagina on speculum examination.
• Lesion suspicious of cancer on clinical examination of the vulva.
• Palpable pelvic mass not obviously fibroids.
• Suspicious pelvic mass on pelvic ultrasound.
• More than one or a single heavy episode of postmenopausal bleeding (PMB) in women aged > 55 years who are not on HRT.
• Postcoital bleeding (PCB) age > 35 years that persists for more than 4 weeks.
• HRT: unexpected or prolonged bleeding persisting for more than 4 weeks after stopping HRT.

Early Referral

Indications for ‘early’ referral (i.e. within 4-6 weeks) but not ‘urgent’ referral.

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

NB. In women over 45 years with persistent abdominal pain or distension, ovarian cancer should be considered and a pelvic examination performed. Referral Guidelines for Suspected Cancer