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Female gynaecological cancer or tumour (A/P-AFF)

Individual from a family in whom a mutation in a cancer predisposition gene has NOT been identified (Adult and Paediatric Conditions in AFFECTED Patients)

Emergency referrals

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • No referrals to emergency relating to genetic testing or review

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Endometrial cancer fulfilling Category 3 criteria and at least one of the following:
    • metastatic
    • endometrial carcinosarcoma
    • uterine serous papillary carcinoma
  • Ovarian cancer with recent active disease (eg within the last 3 years) and at least one of the following:
    • invasive grade 2/3 non-mucinous, epithelial ovarian, fallopian tube or primary peritoneal adenocarcinoma (regardless of age)
    • invasive non-mucinous epithelial ovarian, fallopian or primary peritoneal cancer where there is also a personal history of breast cancer (regardless of grade and age)
    • invasive non-mucinous epithelial ovarian, fallopian or primary peritoneal cancer where there is Jewish ancestry (regardless of grade and age)
    • invasive non-mucinous epithelial ovarian, fallopian or primary peritoneal cancer (regardless of grade and age) where there is one or more close relative with:
      • ovarian cancer
      • breast cancer
    • invasive mucinous or non-mucinous ovarian cancer at any age in which tumour testing detected abnormal MMR immunohistochemistry or microsatellite instability (MSI)
    • invasive mucinous or non-mucinous epithelial ovarian cancer at any age and a first or second degree relative with a Lynch syndrome associated tumour or cancer
    • ovarian cancer where somatic BRCA1 and BRCA2 gene testing has identified a mutation in tumour tissue
    • small cell ovarian carcinoma hypercalcaemic type
  • Adenoma malignum of the cervix

Category 2

Appointment within 90 days is desirable

  • A patient who fulfils Category 3 criteria and has a limited life expectancy due to advanced age and/or co-morbidities
  • Previously treated ovarian cancer (as per Category 1 criteria) in continuous remission for ≥ 3 years
  • Ovarian sex cord tumour with annular tubules (SCTAT)

Category 3

Appointment within 365 days is desirable

  • Personal history of endometrial carcinoma and a family history of one or more first or second-degree relatives with Lynch syndrome associated tumour or cancer.
  • Endometrial carcinoma and features of Cowden syndrome (further information can be found on the GHQ website)
  • Endometrial carcinoma diagnosed at age < 50 years
  • Endometrial carcinoma or adenocarcinoma of the cervix where tumour testing detected abnormal MMR immunohistochemistry or microsatellite instability (MSI) (except where there is loss of expression of MLH1, and hypermethylation of the MLH1 promoter) (further information can be found on the GHQ website)
  • Personal history of endometrial carcinoma and a second Lynch syndrome associated cancer (further information can be found on the GHQ website)
  • Serosal tubal in situ carcinoma (STIC)
  • Sertoli-Leydig cell tumour
  • Ovarian fibroma or leiomyoma
  • Multiple symptomatic uterine leiomyomas before age 40 with clinical features suggestive of Hereditary Leiomyoma Renal Cell Carcinoma (HLRCC) Syndrome

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • The offer of an appointment by GHQ does NOT guarantee that the patient will be offered a publicly funded gene test.
  • If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene please refer to the Untested blood relative  condition within the Genetics CPC
  • If the patient has undergone mainstreamed and/or private genetic testing refer to the Mainstreamed or private testing condition within the Genetics CPC
  • Eligibility for publicly funded genetic testing will be determined using eviQ criteria (See criteria Lynch syndrome and PTEN).
  • Patients will be asked to provide detailed family information either during a telephone consultation (if urgent) or via a family history questionnaire (Cat 3). One or more Consent to Release information forms may be provided to forward to family members to obtain their consent to confirm details of the reported family history.
  • MLH1 promoter methylation studies should be arranged prior to referral for patients with loss of MLH1 and PMS2 staining on mismatch repair immunohistochemistry (further information can be found on the GHQ website).
  • For patients with cancers that have loss of MSH2 and MSH6, isolated loss of MSH6 or isolated loss of PMS2 on immunohistochemistry, referral for colonoscopy at the same time as genetic referral should be considered.
  • If the patient fulfils eviQ criteria for genetic testing and has a very limited life expectancy, arrange for two separate blood collections of 2x4mL EDTA tubes each to be sent to the Molecular Genetics Laboratory, Pathology Queensland (RBWH) for “DNA extraction and storage” prior to or at the time of referral. Advise Pathology Queensland that these specimens have been collected in accordance with Genetics Health Queensland protocols.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • As much detail as possible about the patient’s personal history of cancer including the following:
    • type/s of cancer
    • age at diagnosis
    • treatment including outcome
    • relevant pathology including results of IHC for mismatch repair proteins (and of MLH promoter methylation testing for tumours with loss of MLH1 and PMS2) (if results are available on Auslab please indicate this on referral). If tumour has loss of MLH1 and PMS2 and patient fulfils other criteria for referral, please confirm that MLH1 promoter methylation testing has been ordered.
    • known details of relevant family history

Additional useful information (useful for processing the referral)

  • If the family is known to GHQ, include the GHQ reference number (GF) if known

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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