Suspected Gynaecological Cancer Recognition & Referral

1. Suspected Gynaecological CancerRecognition & 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. Recommendations Incorporate NICE Guidelines OVARIAN CANCERNICE 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