Gynaecological Cancers

Referral route 

Urgent suspected cancer (“2ww”) gynaecology referrals are managed on e-RS by a ‘Referral Assessment Service (RAS)’. This means appointment bookings cannot be made by the referrer and will ‘defer to provider’. Please refer into ‘2ww Gynaecology RAS’. We will then triage your referral and book the patient into one of our gynaecology services:

• 2ww Acute Gynaecology
• 2ww Colposcopy ¹
• 2ww One Stop Hysteroscopy
• 2ww Vulval ² 

¹ Colposcopy - post-coital bleeding below age 35 years should be referred as routine colposcopy. If the patient is post-menopausal and experiencing post coital bleeding, please refer 2ww colposcopy. 

² Vulval service is not suitable for infective vulvovaginitis, Bartholin’s cyst/abscess, cosmetic issues e.g. request for labial reduction, and pelvic floor problems. 

Possible procedures on typical USC (“2ww”) pathway 

Acute Gynaecology

• Physical examination
• Ultrasound Scan
• Diagnostic hysteroscopy
• Polypectomy
• Resection of fibroid
• Endometrial biopsy
• Removal/insertion of coil (as part of the urgent suspected cancer procedures)
• Division of adhesions 

Colposcopy

• Colposcopy of the cervix
• Treatment of CIN (cervical intra-epithelial neoplasia)
• Cervical biopsy, vaginal biopsy 

Hysteroscopy 

Transvaginal scan will be carried out to determine if hysteroscopy is required. If confirmed, we will then do hysteroscopy. 

Vulval 

Examination, vulvoscopy, vulval biopsy. There is a chaperone during examinations and scans. 

Essential tests prior to referral

• Acute Gynaecology - none
• Colposcopy - please do speculum examination for suspicious cervix referral
• One Stop Hysteroscopy - None
• Vulval - physical examination 

Optional tests (concurrent to referral) or other useful information

• Acute Gynaecology - If the patient has had a previous scan please attach
• Colposcopy - none
• One Stop Hysteroscopy - None
• Vulval - FBC, HbA1c, Thyroid function, autoimmune screen 

Things the hospital or patient need to know

• Acute Gynaecology - please specify in the referral if the patient has any mobility problems (if hoist is required) and if an advocate is required. Please ensure transport is booked and please ensure patient has hysteroscopy information leaflet: https://www.nhs.uk/tests-and-treatments/hysteroscopy
• Colposcopy - not applicable
• One Stop Hysteroscopy - please specify in the referral if patient is on blood thinners
• Vulval - Please let us know if the patient requires an advocate, interpreter or if they have mobility problems 

What the hospital tells the patient in letters 

Acute Gynaecology 

‘We try hard to minimise delays in clinic. Please allow up to 2 hours for your appointment. You may have an ultrasound scan during your visit.   

Please note, we have both male and female Gynaecologists. If you only wish to see a female Gynaecologist, contact us on 020 8510 5099 so we can try to meet your request. This may mean you have to wait longer for an appointment. Certain clinics are only run by male Gynaecologists. If so, we will not be able to give you an appointment with a female Gynaecologist.’ 

Colposcopy 

‘We try hard to minimise delays in clinic. Please allow up to 2 hours for your appointment. You may need a biopsy or treatment during your visit. Please ensure you have a proper meal and take painkillers that you are used to taking, e.g. Paracetamol or Ibuprofen 1 hour before your appointment.