GPAtlas🧭 When to suspect
This article covers the four gynaecological cancers a GP must recognise and refer from the history, examination and bedside tests: endometrial (womb), cervical, vulval and vaginal cancer. (Ovarian cancer is the fifth gynaecological cancer and is addressed separately.) In primary care the task is not to make the diagnosis but to spot the red flag, examine, and refer promptly on the right pathway.
The single most important symptom is postmenopausal bleeding (PMB) – unexplained vaginal bleeding more than 12 months after periods have stopped because of the menopause – which is the cardinal sign of endometrial cancer. For the other three, recognition rests largely on examination: a cervix that looks consistent with cancer, an unexplained vulval lump, ulcer or bleeding, or a palpable vaginal mass. Most women with these symptoms do not have cancer, but the cost of a missed cancer is high, so the threshold to examine and refer is deliberately low.
The referral route is a suspected cancer pathway referral – an urgent referral for an appointment within 2 weeks, commonly called a ‘2-week-wait’ (2WW) referral. Make it promptly so the appointment falls within that window.
| Cancer | Key primary-care trigger | Referral action |
|---|---|---|
| Endometrial | PMB not attributable to HRT | 55+: refer on 2WW. Under 55: consider 2WW |
| Endometrial (other route) | Age 55+ with new vaginal discharge, or visible haematuria with abnormal bloods | Consider urgent direct-access ultrasound |
| Cervical | Cervix appears consistent with cancer on examination | Consider 2WW – do not wait for a smear |
| Vulval | Unexplained vulval lump, ulceration or bleeding | Consider 2WW |
| Vaginal | Unexplained palpable mass in or at the entrance to the vagina | Consider 2WW |
Source: NICE NG12 · NHS Cervical Screening Programme
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