Carcinoma of the Cervix
Adult

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Emergency Referrals

Useful Management Information

If radiology is coming from external source (NOT GCUH) contact radiology provider and ask them to transfer images to the GCUH PACS system prior to your referral.

Specifically MRI Pelvis and PET CT must be ordered by a specialist to be fully rebatable. Therefore, if referral originating from primary care, please contact gynaeoncology team for assistance in organizing these tests.

Clinical Resources

National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Invasive cancer (squamous, glandular, other) SCC/adenocarcinoma in histopathology from endocervical polyp
Category 2 (appointment within 90 calendar days)	No Category 2 criteria
Category 3 (appointment within 365 calendar days)	No Category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Biopsy result OR cervical cytology predictive of carcinoma
FBC
UEC
MRI (if cancer histologically proven AND macroscopic disease)
- PET-CT (if cancer histologically proven AND macroscopic disease or for Stage 1A2 disease on excisional biopsy (diagnosed by microscopy only with depth of invasion >3mm and <5mm)).
- ECOG status
- If the patient has had a diagnostic procedure with a specialist prior to referral please include the details of the operation/procedure and the findings.

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Nil additional referral information for this condition

Send Referrals To

Smart Referrals

Preferred Method About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Gynaecology Oncology (E-Blueslips)

Fax

(07) 5687 4497

Post

Gynaecology Oncology, Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 744 284

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Helen Green

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Carcinoma of the CervixAdult