Refer urgently patients:

• with clinical features suggestive of cervical cancer on examination. A smear test is not required before referral, and a previous negative result should not delay referral
• not on hormone replacement therapy with postmenopausal bleeding
• on hormone replacement therapy with persistent or unexplained postmenopausal bleeding after cessation of hormone replacement therapy for 6 weeks
• taking tamoxifen with postmenopausal bleeding
• with an unexplained vulval lump
• with vulval bleeding due to ulceration
• Consider urgent referral for patients with persistent intermenstrual bleeding and negative pelvic examination

Refer urgently for an ultrasound scan patients:

• with a palpable abdominal or pelvic mass on examination that is not obviously uterine fibroids or not of gastrointestinal or urological origin. If the scan is suggestive of cancer, an urgent referral should be made. If urgent ultrasound is not available, an urgent referral should be made

Note - in women over 45 years with persistent abdominal distension or pain, ovarian cancer should be considered and therefore a pelvic examination performed.

Reference:

1. NICE (June 2005). Referral Guidelines for Suspected Cancer
2. Referral Guidelines for Suspected Cancer (April 2000). NHS Executive.