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Gynaecology - USC (2WW)

Checked: 23-07-2023 by Vicky Ryan Next Review: 23-07-2025

Service Overview

Services run at UHBW (St. Michael’s and Weston) and NBT (Southmead). 

Patients may be triaged straight to test eg. USS, CT, MRI or hysteroscopy

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

Referral Guidance

Refer using the Suspected Gynaecological Cancer Referral Form (word doc).

Please inform patients that they may have a hysteroscopy when they attend their first OPA

Referrals to NBT 

Please note: This service is moving to a RAS at NBT from 21/11/22. Therefore, you need to select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.

If advised to refer into MDT, then please submit an Urgent Suspected Cancer (2WW) referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

Please see NICE Cancer Guidelines 2015 - Gynaecological Cancer

Safety netting of all patients with symptoms that are not referred is crucial.

Ovarian Cancer

Ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).

            Refer on Urgent Suspected cancer (2WW) pathway 

If patient c/o following symptoms on a persistent or frequent basis then investigate in primary care with CA125 and other tests as indicated

  • 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 urgency and/or frequency.
  • Symptoms that suggest IBS which rarely presents for the first time in women over the age 50

Also consider requesting a CA125 for patients with ovaries who have unexplained weight loss, fatigue, or changes in bowel habit.

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

If the ultrasound suggests ovarian cancer, refer the patient on a gynaecology urgent suspected cancer (2WW) pathway

For any patient with ovaries who has a normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound, consider other clinical causes of symptoms and investigate as appropriate.

Persistently raised CA125

Please see the Ovarian conditions page for advice on indications for a CA125 test.

Carbohydrate antigen 125 (CA125) is an antigen used in the diagnosis of epithelial non-mucinous ovarian cancers. CA125 may be elevated in many benign and malignant conditions. CA125 is expressed in tissues derived from embryonic coelomic epithelia. These include the endometrium, mullerian epithelium, peritoneum, pleura and pericardium, hence it can be raised in gynaecological and non-gynaecological disease.

How to investigate persistently raised CA125


NB – if Ca-125 is static or rising with no other obvious cause and CT reported as normal, please consider urgent referral to gynaecology as rarely atypical ovarian cancer may present this way and findings on CT can be subtle.

Endometrial Cancer

Post-menopausal bleeding (not on HRT):  Refer on Urgent Suspected cancer (2WW) pathway

Bleeding on HRT please see the Abnormal Vaginal Bleeding page

Consider a direct access ultrasound scan to assess for endometrial cancer in individuals with a cervix aged 55 years and over with:

  • 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 levels, or
      • Thrombocytosis, or
      • High blood glucose levels.

**Post menopausal bleeding = bleeding >12months after menstruation has stopped because of the menopause **

Cervical cancer

Refer on gynae Urgent Suspected cancer (2WW) pathway if on examination, the appearance of their cervix is consistent with cervical cancer.

These patients may be seen in gynaecology outpatients or colposcopy.

For intermenstrual/post coital bleeding please see Abnormal Vaginal Bleeding on Remedy 

Vulval cancer

Refer on gynae Urgent Suspected cancer (2WW) pathway for vulval cancer in women with an unexplained vulval lump, ulceration, bleeding or concern about vulval intraepithelial neoplasia (VIN).

Patients with a vulval lump and history of infection suggestive of bartholins abscess should be referred urgently to gynaecology emergency clinic.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.