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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

Unexplained
 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.

LINKS AND RESOURCES

Ovarian cancer charity Ovarian cancer action https://ovarian.org.uk/next-gen-research-next-gen-lives/?gclid=Cj0KCQiAxfzvBRCZARIsAGA7YMw4IHCW5ZcEfJQJtJ_mmLBS8RcNQnDef0lBsuVtrwtdgvjyC8Q9pQMaAo-0EALw_wcB

Information and education for GPs from Target ovarian cancer https://www.targetovariancancer.org.uk/health-professionals/information-primary-care

Macmillan top tips for diagnosing ovarian cancer https://www.macmillan.org.uk/_images/ten-tips-early-diagnosis-ovarian-cancer_tcm9-300187.pdf

Ovarian cancer action guide for healthcare professionals https://cdn.ovarian.org.uk/media/documents/OCA_guide_for_healthcare_professionals.pdf

NICE on ovarian cancer https://www.nice.org.uk/guidance/cg122

ACOG Information for patients on Endometrial Cancer https://www.acog.org/Patients/FAQs/Endometrial-Cancer?IsMobileSet=false

An article on recognition of endometrial cancer in Primary Care published in advances in therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910472/

An important document from Cancer Research  UK – Engaging Primary Care in Cervical Screening good practice guide https://www.cancerresearchuk.org/sites/default/files/engaging_primary_care_in_cervical_screening_final.pdf

NICE documents on cervical cancer https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/cervical-cancer/products?ProductType=Guidance&Status=Published

Information for patients on vaginal cancer ( also has a section on information about all gynaecological cancers ) from the  eveappeal https://eveappeal.org.uk/gynaecological-cancers/vaginal-cancer/

 

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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