Guidelines for urgent referral of patients with suspected gynaecological cancer

Lesion suspicious of cancer on cervix or vagina on speculum examination.
Lesion suspicious of cancer on clinical examination of the vulva.
Palpable pelvic mass not obviously fibroids.
Suspicious pelvic mass on pelvic ultrasound.
More than one or a single heavy episode of postmenopausal bleeding (PMB) in women aged > 55 years who are not on HRT.
Postcoital bleeding (PCB) age > 35 years that persists for more than 4 weeks.
HRT: unexpected or prolonged bleeding persisting for more than 4 weeks after stopping HRT.

Indications for 'early' referral (i.e. within 4-6 weeks) but not 'urgent' referral.

Any other women with postmenopausal bleeding not on HRT.
Repeated unexplained postcoital bleeding. NB. In women over 45 years with persistent abdominal pain or distension, ovarian cancer should be considered and a pelvic examination performed.