1. Suspected Gynaecological Cancer Recognition & Referral
Karin Williamson
Consultant Gynaecological Oncologist
Nottingham University Hospitals

2. NICE NG12 June 2015 Replaced 2005 Guidelines
Evidence based recommendations on the recognition and referral of suspected cancer.

3. Just how useful are these guidelines to both primary & secondary care?

4. OVARIAN CANCER NICE CG122 Published 2011
Recommendations Incorporate NICE Guidelines
OVARIAN CANCER NICE CG122 Published 2011

5. Ovarian Cancer

6. Ovarian cancer stats 7378 new cases in UK in 2014 4128 Deaths in 2014
35% survive 10 years or more
21% preventable

7. Refer urgently if clinical examination detects:
1.5.1
Ascites
Pelvic or abdominal mass not obviously fibroids

8. Carry out tests in primary care if a woman esp > 50 years has :
1.5.2
( PARTICULARLY IF > 12x / MONTH )
Persistent abdominal distension or bloating
Feeling full and /or loss of appetite
Pelvic or abdominal pain
Increased urinary urgency or frequency

9. Ovarian cancer symptoms

10. Consider Tests in primary care if:
1.5.3
Unexplained weight loss, fatigue or changes in bowel habit

11. Carry out tests for ovarian cancer
Any woman over 50 has experienced symptoms within last 12 months that suggest new IBS.
IBS rarely presents for first time in a woman of this age

12. What tests?
CA 125 If > 35 IU/ml USS pelvis / abdomen

13. What if tests normal If symptoms ongoing advise return to GP
Assess for other causes of symptoms and investigate if appropriate

14. Endometrial Cancer

15. Uterine Cancer Stats 9324 new cases in UK in 2014
2166 deaths in UK
78% 10 year survival
65% increase in incidence since 1970s
6 in 10 cases are diagnosed at 65+

16. Uterine Cancer Risk Factors
37% are preventable
34% are linked to excess bodyweight
4% linked to inactivity
1% linked to HRT use

17. Refer 2WW PMB > 55 years ( new 2015)
PMB ( unexplained vaginal bleeding > 12 months after LMP)
Consider 2WW referral for PMB <55 years (new 2015)

18. Consider Direct access USS in women >55 years
Unexplained vaginal discharge
ARE PRESENTING FOR FIRST TIME WITH NEW SYMPTOMS
HAVE THROMBOCYTOSIS
REPORT HAEMATURIA

19. Consider Direct access USS in women >55 years
Visible haematuria
AND
Low Hb or
Thrombocytosis or
High blood glucose

21. Cervical Cancer

22. Cervical Cancer Stats 3224 new cases in 2014 890 Deaths in 2014
63% survive 10 years or more
100% preventable

23. Cervical cancer
Consider 2WW if on examination the appearance is consistent with cervical cancer

25. Symptoms of Cervical Cancer
IMB
PCB
PMB
Vaginal Discharge
Dyspareunia
Be wary of these symptoms in women who had defaulted smear tests

26. Vaginal cancer

27. Vaginal cancer stats 254 New cases in 2014 110 deaths in 2014
53% survive 10 years or more
63% preventable

28. Vaginal Cancer Consider 2WW
Unexplained palpable mass in or at entrance to vagina

29. Vulval Cancer

30. Vulval Cancer stats 1313 new cases in 2014 453 deaths in 2014
53% survive 10 or more years
40% preventable

31. Vulval Cancer Consider 2WW
Unexplained vulval lump, ulceration or bleeding

39. Conclusions
National Guidelines for early diagnosis of Gynaecological cancer can be difficult to nagivate in practice
Patients referred on 2WW who do not have cancer may not get their symptoms addressed.
Gynae Oncologists are happy to discuss referrals

40. Thank you for your attention:
Miss Karin Williamson
Mr David Nunns
Mr Jaf Abu
Mr Ketan Gejjar