One-stop Urgent Suspected Cancer (USC) Gynaecology Clinic

Gynaecology is the area of medicine dedicated to women’s health.

The illustrations below may help to explain the names of the anatomy parts of the reproductive organs as referred to by the doctors and nurses:

What is an Urgent Suspected Cancer appointment?

You may have seen your GP with symptoms which may be worrying. Your GP then refers you to the hospital through our Urgent Suspected Cancer appointments system to check that you do not have a cancer. You will then receive an appointment by letter as well as text. 

You may have been referred because you have some of these symptoms:

• Abnormal bleeding eg bleeding in between periods, or continuous bleeding
• Irregular bleeding
• Postmenopausal bleeding:
  • If below the age of 50 years with no period for two years, and then you start to bleed
  • If over 50 years with no period for one year, and then you start to bleed
• Bleeding after sexual intercourse
• Vulval (labia) itching/lump
• Your tummy is becoming bigger or clothes becoming tighter around the waist
• You are passing urine more frequently
• You may be constipated and/or have loose stools (poo).

What is a one-stop clinic? 

A one-stop clinic means that you can see a gynaecology specialist and have tests on the same day. At your first appointment you will see a doctor. A nurse or healthcare assistant (HCA) will be with them so that you are not on your own with the doctor. Depending on your symptoms, you may have any of the following investigations:

• An ultrasound scan to look at the womb (uterus) and ovaries
• A biopsy - taking a tiny piece of tissue from the lining of the uterus, cervix or the labia
• A camera test to look at the lining of the uterus or at the cervix.

Approximately 50% of women referred to a one-stop gynaecology clinic have normal findings and are reassured and discharged from the clinic on the same day.

Attending your appointment

Please attend your appointment and remain in the clinic until you have had all the tests.

• Remember to bring a list of any medications you are currently taking
• Please tell your doctor or nurse if you have any allergies or are taking anti-coagulant medication (blood-thinning agents such as aspirin, warfarin, clopidogrel, apixaban or rivaroxaban)
• Please let us know the best contact phone number for you
• You may bring a family member or friend if you wish
• We will try not to keep you waiting on the day of your appointment, but delays can sometimes happen. You may like to bring something to read or a mobile device with headphones to help pass the time. The length of your appointment will depend on your symptoms and whether we need to carry out tests in the clinic. It is best to allow the whole morning or afternoon for your visit.

What if you cannot attend your appointment?

Please let us know as soon as possible if you cannot come to the appointment so that we can offer it to another patient. Please call the phone number on the top of your letter or in your text message to cancel or to reschedule your appointment.

Should you still come to clinic if you are bleeding?

Yes, still attend your appointment so that the doctor can assess you, including an examination. They may be able to prescribe medication to help stop the bleeding while you are having investigations. 

What will happen at the clinic visit?

• A doctor or nurse who is experienced in gynaecology will examine you and may send you for some further investigations. This leaflet explains what these investigations may include.
• We may arrange for you to have an ultrasound scan on the same day when you attend the clinic or before your clinic appointment.
• At the end of your appointment we will give you a letter summarising the examination and scan findings. The letter may also tell you of the next steps.

What tests might I have?

The information below gives a short explanation of each test. Your doctor will discuss which ones would be appropriate for you and explain what will happen before asking for your consent to go ahead.

Pelvic examination - This is an examination of your abdomen and pelvis. The doctor will be wearing gloves. The doctor will also gently examine inside your vagina or back passage using one finger wearing gloves and using jelly as a lubricant. This physical examination may give us important information. 

Speculum examination - During this examination, a plastic instrument called a speculum is used to look inside your vagina. This examination is like having a smear test. 

Ultrasound scan - There are two types of ultrasound scans: (1) abdominal scan when jelly is placed on your tummy and then a small probe is held against your lower tummy skin to look at the uterus and ovaries; (2) An internal scan (transvaginal scan) when an ultrasound probe about the size of a finger is placed in the vagina. It sends clearer images of the uterus and ovaries to the screen. 

Blood tests - If we see a cyst (similar to a balloon filled with water or blood) on scan, then you may need blood tests to give us information on the type of cyst. Blood tests can also to check how well your kidneys are working, and check your iron levels. 

Pipelle biopsy - If the lining of the womb has thickened, we can take a biopsy (tiny piece of tissue) using a pipelle which looks like a straw. This can be done while you are awake in clinic. The pipelle is gently passed through the vagina and cervix into the uterus. Then tissue is sucked through the straw, and this may cause period-like cramps. The tissue is then sent to the laboratory for analysis. If the neck of the womb is tight or we are unable to obtain a good tissue sample, then you may need a camera test called a hysteroscopy.

Hysteroscopy is a slim camera similar to a telescope which is used to look inside your uterus. With your consent we may take a sample of cells from the lining of the uterus (a biopsy). The procedure is usually carried out while you are awake and sometimes you may need an injection of anaesthetic to the cervix to make it numb. The tissue sample is then sent to the laboratory to check for any abnormal cells. However, if it is difficult to look inside the womb or if uncomfortable, you may need to have a hysteroscopy done under general anaesthetic. This would be carried out on another day.

Colposcopy is performed if you have bleeding after sex or your GP is concerned about the appearance of the cervix. Colposcopy is similar to a cervical smear test. After inserting a speculum into your vagina we apply a solution over the cervix. We look for changes using a slim microscope which is similar to a magnifying glass. Sometimes you may need a biopsy (tissue sample) which feels like a pinch and the tissue is then sent to the laboratory for analysis. During the examination the doctor may also give you an opinion on the cervix, as well as their examination findings.

Vulvoscopy is a closer examination of the outside of the vagina - the vulva (the folds of the skin around the entrance to your vagina). This is done if you have detected a lump or experienced itching. If there is a lump sometimes, we take a biopsy (small tissue sample). 

Getting your results 

• If your biopsy results are normal, we will contact you by letter or by phone to let you know and discharge you back to the care of your GP.
• If your doctor decides that further tests are needed, we will contact you and offer you an appointment. This may be face-to-face or a phone appointment.

Where can I get more information or support?

During your appointment, we will give you time to ask us any questions about what is happening to you. We will also give you any relevant printed information you need.