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Gynaecological Cancer Minimum Standards

Gynaecological Cancer Minimum Standards

Gynaecological Cancer Minimum Standards were introduced to improve care and cancerous disease detection. NICE (National Institute for Health and Care Excellence) introduced the ‘Fast Track Referral System’. This is better known as the ‘2 week wait referral’. This is the time within which a patient must be seen by the relevant Doctor.

There are specific symptoms in specific age groups of women that necessitate a ‘2 week wait’. It is important therefore that if you have concerns about cancer that your GP makes the referral under the 2 week wait rule so that you are seen as soon as possible.

Macmillan’s Rapid Referral Guidelines are based on NICE guidance.   It’s been produced by GPs for GPs with the aim of providing support, guidance and practical referral recommendations. This toolkit supports all of the recommendations in the NICE guideline on suspected cancer: recognition and referral apart from those relating to specific childhood cancers.

Ovarian cancer Gynaecological Cancer Minimum Standards

Urgent referral

Urgently refer (appointment within two weeks) if physical examination identifies any of the following:

  • ascites
  • pelvic or abdominal mass (which is not obviously uterine fibroids).

Urgent investigation

Arrange CA125 and/or ultrasound tests in women (especially if 50 or over) who persistently or frequently (particularly more than 12 times per month) experience the following:

  • persistent abdominal distension (bloating)
  • early satiety and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • new onset symptoms suggestive of IBS (as IBS rarely presents for the first time in women of this age).

Consider CA125 and/or ultrasound tests if a woman reports any of the following:

  • unexplained weight loss
  • fatigue
  • changes in bowel habit (though colorectal cancer is a more common malignant cause).


Endometrial cancer

Urgent referral

Urgently refer women (appointment within two weeks) if they are aged 55 and over with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped due to the menopause).

Consider urgently referring (appointment within two weeks) women aged under 55 with post-menopausal bleeding.

Direct access ultrasound

Consider direct access ultrasound in women aged 55 and over with unexplained symptoms of vaginal discharge who:

  • are presenting with these symptoms for the first time or
  • have thrombocytosis or
  • report haematuria.

Consider direct access ultrasound in women aged 55 and over presenting with visible haematuria and any of the following:

  • low haemoglobin
  • thrombocytosis
  • high blood glucose level.

Cervical cancer

Urgent referral

Consider urgent referral (appointment within two weeks) if the appearance of the woman’s cervix is consistent with cervical cancer.

Accompanying notes:

You do not need a smear test before referral. A previous negative result should also not delay referral.

Vulval cancer

Urgent referral

Consider urgently referring (appointment within two weeks) women with any of the following unexplained vulval signs or symptoms:

  • a vulval lump
  • ulceration
  • bleeding.

Vaginal cancer

Urgent referral

Consider urgently referring (appointment within two weeks) women with an unexplained palpable mass in or at the entrance to the vagina.

Call us today

If you think you may have a claim in relation to a failure to implement the Gynaecological Cancer Minimum Standards then call us in confidence to discuss your issue. We are happy to talk through what has happened and advise you on a potential claim. Call us for FREE on 0800 470 2009 or email Dr Victoria Handley at

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