Recognizing Gynecological Cancer in Primary Care: Risk Factors, Red Flags, and Referrals

Abstract

Early diagnosis of symptomatic gynecological cancer is likely to improve patient outcomes, including survival. The primary care practitioner has a key role to play in this-they must recognize the symptoms and signs of gynecological cancer and make prompt evidence-based decisions regarding further investigation and referral. However, this is often difficult as many of the symptoms of gynecological cancers are nonspecific and are more likely to be caused by benign rather than malignant disease. As primary care is generally the first point of patient contact, those working in this setting usually encounter cancer patients at an earlier, and possibly less symptomatic, stage than practitioners in secondary care. Despite these challenges, research has improved our understanding of the symptoms patients present to primary care with, and a range of tests and referral pathways now exist in the UK and other countries to aid early diagnosis. Primary care practitioners can also play a key role in gynecological cancer prevention. A significant proportion of gynecological cancer is preventable either through lifestyle changes such as weight loss, or, for cervical cancer, vaccination and/or engagement with screening programs. Primary care provides an excellent opportunity to discuss cancer risk with patients and to promote risk reduction strategies and lifestyle change. In this article, the first in a series discussing cancer detection in primary care, we concentrate on gynecological cancer and focus on the three most common forms that a primary care practitioner is likely to encounter: ovarian, endometrial, and cervical cancer. We outline key risk factors, briefly discuss prevention and screening strategies, and offer practical guidance on the recognition of symptoms and signs and the investigation and referral of women with suspected cancer. While this article is written from a UK primary care perspective, much of what is discussed will be of relevance to those working in other healthcare systems.

Keywords: Cancer detection; Cancer diagnosis; Cancer prevention; Cancer referrals; Cervical cancer; Endometrial cancer; General practice; Oncology; Ovarian cancer; Primary care.

Fig. 1

Symptoms and signs of ovarian cancer. Based on 2015 NICE guidelines for suspected cancer recognition and referral

Fig. 2

Investigation and referral of suspected ovarian cancer in primary care. Based on 2015 NICE guidelines for suspected cancer recognition and referral

Fig. 3

Investigation and referral of suspected endometrial cancer in primary care. Based on 2015 NICE guidelines for suspected cancer recognition and referral

Fig. 4

Suggested management of patients presenting to primary care with cervical cancer symptoms. GPs should maintain a high index of suspicion in those with an incomplete screening history