Western Australian Gynaecologic Cancer Service (WAGCS)
The WAGCS provides multidisciplinary care to assist women across WA with gynaecological cancers. The multidisciplinary team includes specialists in Gynaecologic, Medical and Radiation Oncology, Palliative Care, Gynaecologic Pathology as well as cancer nurses, allied health and genetic services. Primary care providers are also part of this team.
Patients may be referred for either opinion only or ongoing management. Referrals are discussed at multidisciplinary team meetings.
Opinion only referral
A multidisciplinary opinion on pathology will be provided, and the service will communicate the meeting recommendation back to the referring doctor only. The patient is not contacted. The recommendation may either be ongoing care with the referring doctor, or the patient is to be referred to WAGCS.
This service does not provide opinions on radiology. Patients requiring a radiology opinion should be discussed between the requesting doctor and the radiology provider.
Ongoing management referral
The referral may be discussed at the multidisciplinary team meeting.
WAGCS will undertake ongoing care and management of the patient. The patient, the referring doctor and GP will be advised of the management plan.
The earliest appointment available for that patient’s problem will be provided. Occasionally the first available appointment for a cancer patient may be four weeks from receipt of referral.
Sometimes the referral is triaged and determined to be unsuitable for our service. If WAGCS does not accept the referral, the referrer will be advised of the options, such as referring back to the referrer or forwarding the referral to another gynaecology service at the discretion of the WAGCS.
Clinical inclusion for referral to WAGCS
- Gynaecologic cancer is histologically confirmed
- Gynaecologic cancer is highly likely such as:
- clinical suspicion of cancer of the vulva, vagina or cervix
- severe atypical endometrial hyperplasia
- ovarian mass with ascites or ovarian mass with a high risk of malignancy index (RMI*)
- Risk reduction counselling and surgery (will be triaged as non urgent)
Clinical exclusion
Radiology opinions should be discussed between the radiology provider and the requesting doctor.
Patients with ACIS and HSIL should be referred to the Colposcopy Clinic.
Post-menopausal vaginal bleeding requiring investigation should be referred to the General Gynaecology service. This includes patients with a co-test cytology suggesting an endometrial lesion.
“Large” ovarian cysts without complex features or low RMI should be referred to the General Gynaecology service.
Frequency of clinic
Clinics are held each week on:
- Tuesday afternoon.
- Wednesday morning.
- Thursday all day.
- Friday morning.
Referral requirements
- Detailed clinical information about the patient.
- Specific clinical concerns and medical history.
- Copies of prerequisite investigations.
- Clearly indicate if referral is for Opinion only or Ongoing Management.
- Clearly indicate that the patient has been advised that their case may be discussed at a multidisciplinary team meeting as this is best practice for complex cases
- For the premenopausal patient, indicate if fertility is desired as this will guide the MDT discussion.
- Advise if the patient has been referred to another Gynaecologist or Gynaecology Clinic for the same problem.
Pre-requisite tests
For all patients referred:
- FBE, UEC, LFT, Coagulation profile.
- Cervical Screening Test history or result.
- Biopsy result / Histology if available.
For confirmed vulvar, vaginal or cervical cancer:
- CT of chest, abdomen and pelvis.
For confirmed endometrial cancer:
- CT chest abdomen and pelvis.
- Do NOT request MRI / PET unless this has been discussed with WAGCS.
For ovarian cancer:
- CA125, CA19-9 and CEA results (provide normal range for laboratory used & copy of result).
- Calculate the Risk of Malignancy Index*.
- Pelvic ultrasound, CT Chest, abdomen and pelvis with report and details of imaging provider(s).
*RMI = ((absolute value of CA125) x (menopausal status) x (Imaging score))
Where premenopause = 1 and post menopause = 3 (menopausal status)
Where simple cyst = 1 and complex cyst = 3 (imaging score)
High RMI is > 200
Urgent referral
Contact the Gynaecologic Oncology Fellow via telephone (08) 6458 2222 to discuss urgent cases that need to be assessed with 7 days.
Referral process
All non-urgent referrals from GPs to this clinic are sent to the Central Referral Service WA (CRS) (external site). Ensure you provide the relevant information in the referral to enable appropriate triage, including required investigation results and letters from treating medical practitioners if relevant and request WAGCS clinic at WNHS.
Referrals using GP software that include all the relevant history and information are also welcome using CRS referral form templates (external site).
Note: Urgent referrals are not accepted at CRS. Urgent referrals must be discussed with WAGCS Fellow or Consultant and sent directly to WAGCS.
Contact information
For clinical advice regarding gynaecologic oncology issues, GPs are always welcome and encouraged to phone KEMH and ask to speak to the Gynaecologic Oncology Fellow or the on-call Gynaecologic Oncology Consultant via phone number (08) 6458 2222.
A Gynaecologic Oncology Clinical Nurse Liaison is available for general queries via phone number (08) 6458 2222.
Useful links
Consumer resources
Cancer Australia (external site)
Cancer council WA (external site)
Jean Hailes: For women's health (external site)
Health professional resources
eviQ (external site)
eviQ is an Australian Government, freely available online resource of cancer treatment protocols developed by multidisciplinary teams of cancer specialists. With a goal to improve patient outcomes and reduce treatment variation, eviQ provides evidence-based information to support health professionals in the delivery of cancer treatments available at the time treatment decisions are being made.