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Gynaecological Cancers (Endometrial, Vaginal, Vulval, and Cervical Cancers)

Reviewed and updated by practising UK GPs, overseen by our Clinical Advisory Officer. Last updated 19 Sep 2025.

🧭 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.

• You need not make the diagnosis: spot the red flag, examine, and refer promptly on the right pathway.

The symptom that matters most is postmenopausal bleeding (PMB), the cardinal sign of endometrial cancer.

• PMB is unexplained vaginal bleeding more than 12 months after periods have stopped because of the menopause.

For the other three cancers, recognition rests largely on examination:

• A cervix that looks consistent with cancer.

• An unexplained vulval lump, ulcer or bleeding.

• 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 (previously the two-week wait). Make it promptly: the aim is a diagnosis, or cancer ruled out, within 28 days.

Cancer Key primary-care trigger Referral action
Endometrial PMB not attributable to HRT

• 55+: refer on the suspected cancer pathway

• Under 55: consider referral
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 a suspected cancer pathway referral – do not wait for a smear
Vulval Unexplained vulval lump, ulceration or bleeding Consider a suspected cancer pathway referral
Vaginal Unexplained palpable mass in or at the entrance to the vagina Consider a suspected cancer pathway referral
Abnormal bleeding, discharge,lump or massHeavy bleeding withhaemodynamic compromise?Emergency admission ifunstableSpeculum + bimanualexamination (chaperone)•exclude pregnancy and infection firstwhere relevant•a recent normal smear never holds areferralPostmenopausal bleeding notattributable to HRT?Aged 55 or over?Refer on the suspected cancerpathwaysuspected endometrial cancerConsider a suspected cancerpathway referral•under 55 with PMB•cervix consistent with cancer: do notwait for a smear•unexplained vulval lump, ulceration orbleeding•palpable mass in or at the entrance tothe vaginaCervix looks malignant, vulvallump, ulcer or bleeding, orvaginal mass?55+ with new discharge, orvisible haematuria withabnormal bloods?Urgent direct-accessultrasound•abnormal bloods: low haemoglobin,thrombocytosis or high glucose•visible haematuria also triggers theurological pathwayLow-risk symptoms not meetingcriteriasafety-net, give return advice, reviewif symptoms changeYESNOYESYESNONOYESYESNONOPMB, examination and the ultrasound routeOcean 🌊GPAtlas Ocean 🌊

Source: NICE NG12 · NHS Cervical Screening Programme

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Inside the full topic 🔒 History🔒 Red Flags🔒 Examination🔒 Patient Explanation🔒 Investigations🔒 Management🔒 Non-pharmacological Treatment🔒 Pharmacological Treatment🔒 Special Notes🔒 Referral Pathways🔒 Take Home Messages

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