NB: Refer Cervical intraepithelial neoplasia (CIN) to Colposcopy –

• Refer to local colposcopy service along with patient’s last 2 pap results
  • QEII Colposcopy and Gyn/Derm Clinic Referral form

For general gynecology fax to your local gynecologist

Required Information for all referrals to Gyne Oncology (surgery and systemic therapy):
(For referral to Radiation Oncology, see Cancer Centre referral page)

• Completed Gyne Oncology Referral form
• Consultation letter highlighting presenting signs and symptoms and findings
• All relevant pathology slides/blocks AND the path report from biopsy/surgical specimen (if done)
• Relevant OR report (If done)
• Disease-specific requirements as outlined below:
  • Cervix
  • Endometrium
  • Gestational Trophoblastic Disease (GTD)
  • Gynecology not otherwise specified
  • Ovary/Pelvic Mass NYD
  • Sarcoma (refer to likely site of origin)
  • Vulva & Vagina (including Vulvar Intraepithelial Neoplasia (VIN) and Vaginal Intraepithelial Neoplasia (VAIN))

Additional disease-specific information (See more below)

Gynecology oncology not otherwise specified
For general gynecology fax to your local gynecologist     

Gestational Trophoblastic Neoplasia (GTD Referral Form)

Endometrium

Cervix

CIN goes to colposcopy with their own referral form

Ovary/Pelvic Mass NYD

• For suspected ovarian cancer/pelvic mass<40 years old

For Suspected ovarian cancer/pelvic mass > 40 years old

Vulva & Vagina including Vulvar Intraepithelial Neoplasia (VIN) and Vaginal Intraepithelial Neoplasia (VAIN)