Cervical Cancer

Emergency department referrals

Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.

Contact on call Oncology Registrar through:

Royal Brisbane & Women’s Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

View the emergency contact details for referring General Practitioners.

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

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

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

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 days is desirable

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 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

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

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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

Additional referral information (useful for processing the referral)

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

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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