Cervical cancer

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Malignant bowel obstruction
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia
    • Refer to local HealthPathways or local guidelines
    • Women with a positive oncogenic HPV (16/18) test result or a (not 16/18) result and possible high-grade lesion should be referred directly for colposcopic assessment through the Gynaecology service. Similarly, if the diagnosis is suspected or confirmed with initial tests, referral to a gynaecological oncologist (and subsequent multidisciplinary team assessment) is appropriate.
    • Newly diagnosed women are discussed in a multidisciplinary team meeting and further investigations arranged appropriately. Issues regarding fertility, early menopause and changes to sexual function should be addressed.
    • Depending on the stage of the malignancy treatment options may include surgery for small tumours found only within the cervix, radiation therapy concurrently with chemotherapy if it is anticipated that surgery will not remove all disease and in certain situations postoperative radiation therapy plus/minus chemotherapy may be recommended. For patients with metastatic disease chemotherapy and immunotherapy may be used as part of the treatment.
    • Serum tumour bio-markers such as CA15-3 or others should not be used as diagnostic tests
    • For women who have not completed their family, fertility preservation needs to be discussed and is often addressed as part of the Gynaecology-Oncology assessment.
    • For patients with incurable (metastatic or recurrent) cancer consider the following:
      • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the woman's prognosis and their understanding of their prognosis
      • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
      • specific patient goals and values that may impact on treatment choices
      • whether the patient has been referred to a palliative or supportive care service
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Patients with early stage or locally advanced Cervical cancer should be referred to the Gynaecology-Oncology surgical team for evaluation and further investigation / staging. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

Women with a positive oncogenic HPV (16/18) test result should be referred directly for colposcopic assessment, informed by the result of the reflex liquid-based cytology. Women with a positive oncogenic HPV (not 16/18) test result with a reflex liquid-based cytology result of possible high-grade lesion or high-grade lesion should be referred directly for colposcopic assessment through the Gynaecology team initially and then will be referred further to the Gynaecology-Oncology MDT as appropriate.

  • Patients requiring chemotherapy and radiation for locally advanced disease (previously biopsy confirmed and discussed in Gynae-Oncology MDT) For optimum care, patient should be seen within 2 weeks.
  • Patients requiring adjuvant chemotherapy (biopsy confirmed) For optimum care, patient should be seen within 2 weeks.
  • Metastatic cervical cancer (biopsy confirmed).
Category 2
(appointment within 90 calendar days)
  • Patients with previously treated locally advanced cervical cancer that required chemotherapy and require routine follow-up
  • Transfer of care from another health service
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Previous cancer treatment details including location; dates; treating doctor; details of prior treatment regimes and imaging / pathology results.
  • Previous screening test results
  • FBC, ELFTs results
  • Histology /cytology results – current +/- previous
  • CT chest, abdomen and pelvis and MRI pelvis reports

3. Additional referral information Useful for processing the referral

  • Other available imaging  (e.g. PET imaging reports)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 January 2025

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