Faster Diagnosis Pathway for Gynaecology

Why am I receiving this information leaflet?

• You have been referred to a gynaecology specialist on the "Faster Diagnosis Pathway" because your symptoms need further investigation.

• This pathway ensures that the right tests are performed as quickly as possible so that your doctor can rule out cancer as the cause of your symptoms.

• The majority of women referred on this pathway do not have cancer and will receive reassuring results.

• However, it is important that you come for any tests or appointments offered so that, if you do have a cancer, it can be diagnosed and you can start treatment as soon as possible.

• This can be a very worrying time for you and your family.

• We aim to keep the time between your referral, diagnosis and treatment (if you need it) as short as possible. We need your help to make this happen.

• This leaflet aims to give you an overview of what you can expect during this time. Not all elements of the pathway may apply to you depending on the symptoms you have experienced.

Glossary

Biopsy

• A biopsy is a sample of tissue taken from the body in order to examine it more closely.
• A doctor may recommend a biopsy where there is a suggestion that an area of tissue in the body isn't normal. Most biopsies are done under local anaesthetic.

CT scan

• A CT scan uses X-rays to take detailed pictures of your body from different angles. A computer then puts them together to give a series of pictures.

Drainage

• If you have excess fluid in your abdomen or chest, then it may need to be removed. This involves inserting a small plastic drain, with local anaesthetic.

Gynaecological cancer

• Gynaecological cancers start in a woman's reproductive system.
• There are five types - womb (also known as endometrial), ovarian, vulval, vaginal and cervical.

Hysteroscopy

• A hysteroscopy is a procedure to examine the inside of the womb, using a hysteroscope. This is a narrow telescope with a light and camera at the end.
• Some women experience discomfort during this procedure - your doctor or nurse can tell you more about what to expect and about how to prepare for the test.

MDT (Multi- disciplinary Team)

• An MDT meeting is a meeting of the group of professionals who together make recommendations regarding treatment of individual patients.
• This includes consultant oncologists, surgeons, specialist nurses and imaging specialists.
• You will not need to attend this meeting.

MRI scan

• An MRI scan uses a combination of a powerful magnet and radio waves to scan your body. - It will provide us with detailed images of your pelvis.

Specialist centre

• Some hospitals provide specialist treatment for patients with gynaecolgoical cancer.
• In North Central London the specialist centre is at University College London Hospitals (UCLH).
• You may be referred to UCLH if this is the best place for your diagnosis and treatment.

Ultrasound scan

• Ultrasound scans use high frequency sound waves to build up a picture of the inside of the body.
• The sound waves bounce off the organs inside your body, and a computer turns the sound waves into a picture on the screen.
• They are usually done in the hospital x-ray or gynaecology department by a sonographer.
• Most pelvic scans are performed with a probe inserted into the vagina to get the best images.

Faster diagnosis pathway

• The appointments and tests you may need to have to investigate your symptoms are described as a 'pathway'.
• This diagram shows the order of the appointments from referral to treatment.
• You may not need all of these tests.
• If cancer is ruled out early in the pathway, you will not need the rest of the tests.

What will happen on this pathway?

Day 0 - GP referral to local hospital

• Your GP will refer you to your local hospital, who will aim to offer you an appointment within 9 days or less.

By day 9 - First appointment

• You may be asked to have tests such as an ultrasound and a biopsy. These tests will be performed on the same day as you see the gynaecologist, if possible.
• You may be offered a hysteroscopy at your first appointment, or this may be arranged separately depending on what is appropriate. A hysteroscopy may be performed under general anaesthetic if it has not been possible to perform this under local anaesthetic.
• Further tests such as CT and MRI scans may also be required.
• The gynaecologist will discuss with you how you will receive the results.
• This may be by letter, telephone or in person.

By day 18 - MDT Meeting

• Unless cancer has been ruled out, the results may need to be discussed at a Whittington Health multidisciplinary team (MDT) meeting of healthcare professionals.
• An onward referral to University College Hospital specialist centre may be required.

By day 28 - Specialist MDT meeting at UCLH (if required)

• All of your test results from your local hospital will be need to be reviewed at this specialist meeting.
• Additional tests such as scans or biopsies may be requested before the team at UCLH see you to discuss a plan for your treatment.
• The specialist centre team will review all of your tests and consider what treatment should be recommended.

Within 1 week of the specialist MDT meeting

• The UCLH specialist team will aim to see you within one week of having reviewed all of your tests to explain your diagnosis.
• If you need treatment, the different options will be discussed in detail with you.
• We aim to begin treatment within 62 days of referral by your GP.

By day 62 - Start treatment

• If your test results show that you have cancer, or if you need to be referred to UCLH for more tests or treatment, you will be supported by a Clinical Nurse Specialist (CNS).
• Your CNS will help guide you through the next steps in your care and answer any questions you may have.
• You may be offered genetic tests. These tests can help your healthcare team decide which treatments may work best for you.
• You may also be given information about research studies that you may be able to take part in.

If you have any questions at any point, you can contact us Monday- Friday, 9am-5pm on 0207 288 3118.

What you need to do next

• You may be contacted at short notice to attend appointments.
• It is very important that you attend all the appointments we offer you.
• Delaying these appointments or tests may mean it takes longer to find out what is wrong and start any treatment you may need.
• Please be available for the next six weeks for appointments.
• These timings are the national requirements for hospitals to provide a rapid service to patients.
• This is so that people who need treatment can start it as soon as possible. However, this is so that may be seen more quickly than this.
• Please let us know if you change your contact details.
• There are two videos available in multiple languages on our website which explain what to expect during:
  • a Rapid Access appointment
  • a hysteroscopy appointment (should you need one).
• You can access these using the link:

https://www.whittington.nhs.uk/?c=28356

• If you cannot attend an appointment or are planning to go away, please discuss this with your GP practice or hospital doctor or nurse as soon as possible.
• Please reschedule any trips/holidays if possible.
• If you have an emergency and cannot keep your appointment, please let us know immediately by calling this number: 0207 288 5118.
• You will then need to arrange another appointment.
• We suggest that you bring a friend or family member to appointments if you can.
• Please bring a list of your current medications.
• If a translator/interpreter is required, please let the hospital know in advance.
• If you need transport to and from the hospital, please speak with your GP who can advise how this can be arranged.

Managing your feelings whilst waiting for your results

• You might notice a range of emotions whilst waiting for your results.

• Many people tell us that they feel anxious. Others might feel numb or notice that things don't seem real.

• Sometimes people find it harder to concentrate or remember things.

• There is no "normal" way to feel during this period, so try to be kind to yourself whatever emotions you are experiencing.

• If you are feeling anxious, you might notice changes in your body, for example:

  • increased heart rate
  • muscle tension
  • breathing more quickly
  • feeling hot and sweaty
  • racing thoughts and butterflies in your stomach.

• These are all normal responses to a worrying situation and are your brain and body's way of trying to keep you safe.

• Over time these physical feelings should lessen.

You may find the tips below helpful for managing your feelings during the wait

• Find ways to express how you feel. You may find it helpful to talk to someone you trust, such as a friend or family member. You could also try writing or drawing about your feelings.
• Distraction. Try to engage with activities that occupy your mind. Try to include a mixture of activities that give you a sense of achievement, a sense of enjoyment and a sense of closeness to other people. Try to really pay attention to what you are doing, even though your mind might keep trying to distract you.
• Movement. Physical activity can help us to feel calmer, both physically and mentally. This can be as simple as some slow stretches of your body or going for a short walk.
• Slow your breathing. When we are going through something stressful, we tend to breathe more quickly, shallowly and from the chest. Purposefully slowing your breathing and breathing from lower in your abdomen can help to calm your body and mind.
• Try breathing in slowly and steadily for four seconds. Pause for a second. Then breathe out slowly and steadily for four seconds and pause for another second. Try breathing like this for a minute or two and see how you feel.

Engaging with healthcare if you have experienced trauma

• We know that for some people who have experienced trauma, particularly sexual violence, healthcare appointments can be difficult.
• We want to do everything that we can to make you feel comfortable, so please do let us know if there are things that you would like us to do (or not do) to help you feel safe.
• We will not ask you to tell us about your experiences if you do not want to.
• We understand that it can also be difficult to share that you have experienced trauma.
• You can show this section of the leaflet to your healthcare professional if you have had experiences that make healthcare appointments difficult for you.
• It may help them understand how you feel, especially if it is hard to explain in words.