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Gynaecological cancers

Ovarian cancer-NICE recommends an urgent
 ( ie USC to be seen within 2 weeks ) referral 
if physical examination reveals
 ascites and / or a pelvic / abdominal mass
which is not obviously uterine fibroid

NICE recommends testing in primary care for ovarian cancer if a woman ( particularly over 50 ) reports having any of the following symptoms on a persistent or frequent basis – particularly more than 12 times/ month-persistent abdominal distension 
( women often refer to this as bloating ) feeling full ( early satiety ) and / or loss of appetite pelvic or abdominal pain increased urinary frequency and / or urgency

 weight loss fatigue changes in bowel habit-Women 50 or over who has experienced symptoms within last 12 months that suggest irritable bowel syndrome 
( IBS rarely presents for the first time in women of this age )-check Ca 125.CA 125 normal or ( ie less than 35 IU/ml ) or CA 125 of 35 IU/ml or greater but normal ultrasound.Assess carefully for other clinical causes of her symptoms and investigate if appropriate
 If no other clinical cause is apparent , advise to return if her symptoms become ↑ frequent and / or persistent

Endometrial cancer

Age 55 and over with post-menopausal bleeding. 

NICE gives a clear definition of PMB ” unexplained vaginal bleeding more than 12 months after menstruation has stopped because of menopause “
 Consider a USC referral ( for appt within 2 weeks ) in women aged under 55 with post-menopausal bleeding

Aged 55 and over –Unexplained symptoms of vaginal discharge who 

○ are presenting with these symptoms for the first time OR
○ have thrombocytosis OR
○ report haematuria OR
 Visible haematuria and 

○ low haemoglobin OR
○ thrombocytosis OR
○ high blood glucose levels-Consider -direct access* ultrasound scan to assess for endometrial cancer.Direct access* according to NICE is when a test is performed and primary care retain clinical responsibility throughout , including acting on result. Please mention -Direct access referral to r/o endometrial carcinoma clearly on the referral form.

Cervical cancer – Consider a USC ( appt within 2 weeks ) if on examination the appearance of their cervix is consistent with cervical cancer .

Vulval cancer-Consider a USC ( appt within 2 weeks ) in women 
with an unexplained vulval lump , ulceration or bleeding

Vaginal cancer-Consider a USC ( appt within 2 weeks ) in women with an unexplained palpable mass in or at the entrance of the vagina.


Ovarian cancer charity Ovarian cancer action

Information and education for GPs from Target ovarian cancer

Macmillan top tips for diagnosing ovarian cancer

Ovarian cancer action guide for healthcare professionals

NICE on ovarian cancer

ACOG Information for patients on Endometrial Cancer

An article on recognition of endometrial cancer in Primary Care published in advances in therapy

An important document from Cancer Research  UK – Engaging Primary Care in Cervical Screening good practice guide

NICE documents on cervical cancer

Information for patients on vaginal cancer ( also has a section on information about all gynaecological cancers ) from the  eveappeal


References Suspected cancer : recognition and referral NICE guideline NG 12 June 2015 Updated July 2017 NICE Pathways – ovarian cancer : detection in primary care


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