Hearing that you may need further tests for suspected cancer can make you feel worried and anxious. However, understanding what should happen next can help you feel more informed and prepared.

During Gynaecological Cancer Awareness Month, it is important to raise awareness not only of the symptoms of gynaecological cancers, but also of the pathways that exist to help ensure patients receive the investigations and, if necessary, the treatment they need as quickly as possible.

In this blog, we explain how the referral process works, what you can expect if your doctor suspects a form of gynaecological cancer, and what steps you can take if you are concerned about delays.

What is gynaecological cancer?

Gynaecological cancers are cancers that start in the female reproductive system.

The five main types are:

• Ovarian cancer
• Womb (endometrial) cancer
• Cervical cancer
• Vulval cancer
• Vaginal cancer

Each type of cancer can present with different symptoms, which is why it is important to seek medical advice if you notice anything unusual or persistent.

When should you see your GP?

Many symptoms associated with gynaecological cancers can also be caused by less serious conditions. However, it is still important to get them checked.

Symptoms that should be discussed with a GP include:

• Abnormal vaginal bleeding
• Bleeding after the menopause
• Bleeding after sex
• Persistent bloating or feeling full more quickly
• Ongoing unexplained pelvic or abdominal pain
• Changes in bowel or bladder habits
• A lump or swelling in the abdomen
• Unexplained weight loss
• Vulval itching or skin changes that do not improve

While having one or more of these symptoms does not mean you have cancer, early investigation can help identify the cause and, where necessary, lead to earlier treatment.

What happens at your GP appointment?

Your GP will usually ask about:

• Your symptoms
• How long you have been experiencing them
• Your medical history
• Any family history of cancer
• Any factors that may increase your risk

Depending on your symptoms, your GP may carry out an examination, arrange tests, or refer you to a specialist.

You may be asked to have blood tests, an ultrasound scan, or other investigations before or after being referred.

What is an urgent suspected cancer referral?

If your GP believes your symptoms may be caused by cancer, they may make an urgent referral to a specialist under the NHS urgent suspected cancer pathway (USC), previously known as the two-week wait referral.

Many people worry when they hear the words "urgent referral", but it is important to remember that most people referred for suspected cancer are ultimately not diagnosed with cancer.

The purpose of the urgent referral system is to ensure that people with possible cancer symptoms are assessed promptly so that any necessary treatment can begin as early as possible. The NHS aims to provide a definitive diagnosis or rule out cancer within 28 days of your GP's urgent referral.

What happens after a referral?

Once a referral has been made, you may be invited to attend a hospital or specialist clinic for further investigations.

These may include:

Ultrasound Scans: Commonly used to investigate symptoms associated with ovarian and womb cancers.

Hysteroscopy: Involves examining the inside of the womb using a thin camera. It may be recommended if you are experiencing abnormal bleeding, particularly after the menopause.

Biopsy: A small sample of tissue may be taken and examined to determine whether cancer cells are present.

MRI, CT or other imaging scans: Further imaging can help clinicians assess whether cancer is present and determine the most appropriate treatment options.

What if your symptoms continue?

If your symptoms continue, worsen, or return, it is important to seek further medical advice, even if previous investigations were reassuring. A normal test result doesn’t always mean there is nothing wrong if symptoms continue.

You know your body better than anyone else, and persistent symptoms should not be ignored simply because an earlier test did not identify a cause.

How can you take an active role in your care?

There are several steps that patients can take to help ensure concerns are fully understood and addressed:

Keep a symptom diary

Make a note of:

• Your symptoms
• When they occur
• How often they happen
• Whether they are getting worse

This can help you communicate clearly your symptoms and allows the healthcare professional to build a clearer picture of what you are experiencing.

Don’t be afraid to ask questions

Consider asking:

• What could be causing my symptoms?
• Do I need any further tests?
• When should I expect my results?
• What should I do if my symptoms continue?

Follow up on results

If you have waited more than seven days for an appointment date since your urgent suspected cancer referral was made, contact your GP for an update. If you are waiting longer for your test results than communicated to you, contact your GP surgery or hospital department to check on progress.

When can delays become a concern?

Most patients receive appropriate investigations and treatment. However, delays can sometimes occur.

Examples may include:

• Delays in referring a patient for specialist assessment
• Delays in arranging diagnostic tests
• Abnormal test results not being acted upon
• Symptoms being repeatedly attributed to less serious conditions without appropriate investigation

Not every delay amounts to medical negligence. However, if a delay in diagnosis or treatment has resulted in avoidable harm, it may be appropriate to seek specialist legal advice.

Why understanding helps

Understanding the gynaecological cancer referral process can help patients feel more confident when seeking medical advice and navigating investigations.

While most people referred for suspected cancer will not receive a diagnosis of cancer, recognising symptoms, attending appointments promptly, and following up on ongoing concerns can all play an important role in achieving the best possible outcome.

Most importantly, if something does not feel right, trust your instincts and seek medical advice. Early investigation can provide reassurance, identify other causes, or help ensure that treatment begins as soon as possible if cancer is diagnosed.