Gynaeoncology Service

The Gynaeoncology Service offers a comprehensive diagnostic, treatment and management service for women with precancerous and cancerous gynaecological conditions.

Specialities 

Gynaecological cancers, precancerous gynaecological conditions, risk reduction, gestational trophoblastic disease (hydatidiform mole).

The Gynaeoncology Service provides the only intervention proven to significantly reduce mortality due to ovarian cancer in women at high inherited risk of ovarian cancer; risk-reducing bilateral salpingo-oophorectomy (RRBSO).

An information resource for health professionals Managing Women at High Risk of Ovarian Cancer can be downloaded from this web page. 

Clinical inclusion

All women or at risk of; or with a known, suspected, gynaecological cancer or precancerous condition can be referred by a GP or specialist doctor.

Frequency

Gynaeoncology Service

	Mon	Tues	Wed	Thur	Fri
AM 09:00-12:30	New Patient Clinic weekly Oncology Pre-admission Clinic		nil	nil
PM 13:30-17:00	Post Operative Review Clinic fortnightly	Multidisciplinary meeting Oncology Clinic (New and Review)	nil	nil	Supportive Care Multidisciplinary Meeting

Triage

A patient who presents with symptoms suggesting gynaecological cancer should be referred to a team specialising in the management of gynaecological cancer

Gynaeoncology clinics

Cervix:   Lesion suspicious of cancer on cervix or vagina on speculum examination

Uterine:  Diagnosis of endometrial cancer or atypical hyperplasia of the endometrium

Vulva:   Biopsy proven cancer of the vulva

Ovary:    Suspicious pelvic mass on ultrasound scan
               Ascites
               Elevated CA 125 (Normal range: 2 – 35)

Specific recommendations

1. The first symptoms of gynaecological cancer may be alterations in the menstrual cycle, intermenstrual bleeding, postcoital bleeding, postmenopausal bleeding or vaginal discharge. When a patient presents with any of these symptoms, the primary healthcare professional should undertake a full pelvic examination, including speculum examination of the cervix.
2. In patients found on examination of the cervix to have clinical features that raise the suspicion of cervical cancer, an urgent referral should be made. A cervical screening test is not required before referral, and a previous negative cervical screen result is not a reason to delay referral.  These referrals will be triaged to the Gynaeoncology Service.
3. Ovarian cancer is particularly difficult to diagnose on clinical grounds as the presentation may be with vague, non-specific abdominal symptoms alone (bloating, constipation, abdominal or back pain, urinary symptoms). In a woman presenting with any unexplained abdominal or urinary symptoms, abdominal palpation should be carried out. If there is significant concern, a pelvic examination should be considered if appropriate and acceptable to the patient.
4. Any woman with a palpable abdominal or pelvic mass on examination that is not obviously uterine fibroids or not of gastrointestinal or urological origin should have an urgent ultrasound scan. If the scan is suggestive of cancer, or if ultrasound is not available, an urgent referral should be made. These referrals will be triaged to the Gynaeoncology Service.
5. Vulval cancer can also present with vulval bleeding due to ulceration. A patient with these features should be referred urgently. These referrals will be triaged to the Gynaeoncology Service or to the Vulval Clinic as appropriate.

The following referrals will be triaged to Gynaecology Units for investigation

1. When a woman who is not on hormone replacement therapy presents with postmenopausal bleeding, an urgent referral should be made. 
2. When a woman on hormone replacement therapy presents with persistent or unexplained postmenopausal bleeding after cessation of hormone replacement therapy for 6 weeks, an urgent referral should be made.
3. Tamoxifen can increase the risk of endometrial cancer. When a woman taking tamoxifen presents with postmenopausal bleeding, an urgent referral should be made.
4. An urgent referral should be considered in a patient with persistent intermenstrual bleeding and a negative pelvic examination.
5. When a woman presents with vulval symptoms, a vulval examination should be offered. If an unexplained vulval lump is found, an urgent referral should be made.
6. Vulval cancer may also present with pruritus or pain. For a patient who presents with these symptoms, it is reasonable to use a period of ‘treat, watch and wait’ as a method of management. But this should include active follow-up until symptoms resolve or a diagnosis is confirmed. If symptoms persist, the referral may be urgent or non-urgent, depending on the symptoms and the degree of concern about cancer.

Referral

Please complete and fax the Fast Fax Referral form.

Urgent referrals

Clinical enquiries will be directed to the Nurse Consultant, Oncology Fellow or Clinical Director.

Appointment

An acknowledgement letter will be sent directly to the patient and the GP will be notified. The patient will then receive a letter with the appointment details.

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