2ww Gynaecology referral

Clinical ascites and/or a pelvic or abdominal mass (not uterine fibroids)

Ultrasound suggests ovarian cancer

≥55yr + post‑menopausal bleeding (uterine cancer)
<55yr + post‑menopausal bleeding (uterine cancer)

Examination of cervix is consistent with cervical cancer
High-grade dyskaryosis (moderate or severe) —> Referred for colposcopy within 2 weeks.  
Suspected invasive cancer or glandular neoplasia —> Referred for colposcopy within 2 weeks. 

Unexplained vulval lump, ulceration or bleeding (vulval cancer)
Unexplained palpable mass in or at the entrance to the vagina (vaginal cancer)

Direct access tests in primary care (serum CA125 +/- ultrasound abdomen and pelvis)(ovarian cancer)

≥50yr + frequent (>12/month) abdominal distension/bloatedness; feeling of fullness and/or loss of appetite, pelvic or abdominal pain, increased urinary urgency and/or frequency

≥50yr + new-onset irritable bowel symptoms

Unexplained weight loss, fatigue or changes in bowel habit

If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.

Direct access tests in primary care (ultrasound abdomen and pelvis)(endometrial cancer)

≥55yr + unexplained vaginal discharge + first presentation discharge/ thrombocytosis/ haematuria

≥55yr + visible haematuria + low haemoglobin/ thrombocytosis/ high blood glucose