Advertisement

Running a Safe Rapid Access Clinic

  • Vivek Nama
Chapter

Abstract

Running a safe rapid access clinic (RAC) is an integral component of cancer services. Efficiency in the delivery of these services requires participation in activities such as multi-disciplinary team (MDT) meetings, adhering to national cancer waiting time targets and performing audits. Referrals to RAC clinic often fall into five categories: postmenopausal bleeding, suspected ovarian, cervical, vulval or endometrial cancer. Standardised forms allow a broader category ‘other’ to include non-specific concerns.

Keywords

Rapid access clinic 2 week wait Cancer referral Cancer services MDT 

References

  1. 1.
    Publication of Cancer Reform Strategy, In: Health Do. London; 2007.Google Scholar
  2. 2.
    SIGN. Investigation of post-menopausal bleeding; 2002.Google Scholar
  3. 3.
    RCOG. Management of suspected ovarian masses in premenopausal women; 2011.Google Scholar
  4. 4.
    Bailey J, Tailor A, Naik R, Lopes A, Godfrey K, Hatem HM, et al. Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: does it identify the correct cases? Int J Gynecol Cancer. 2006;16(Suppl 1):30–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol. 2005;23(34):8794–801.CrossRefPubMedGoogle Scholar
  6. 6.
    Dodge JE, Covens AL, Lacchetti C, Elit LM, Le T, Devries-Aboud M, et al. Preoperative identification of a suspicious adnexal mass: a systematic review and meta-analysis. Gynecol Oncol. 2012;126(1):157–66.CrossRefPubMedGoogle Scholar
  7. 7.
    Burbos N, Musonda P, Duncan TJ, Crocker SG, Morris EP, Nieto JJ. Estimating the risk of endometrial cancer in symptomatic postmenopausal women: a novel clinical prediction model based on patients' characteristics. Int J Gynecol Cancer. 2011;21(3):500–6.CrossRefPubMedGoogle Scholar
  8. 8.
    ACOG. The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding; 2009.Google Scholar
  9. 9.
    Timmermans A, Opmeer BC, Khan KS, Bachmann LM, Epstein E, Clark TJ, et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2010;116(1):160–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Wong AS, Lao TT, Cheung CW, Yeung SW, Fan HL, Ng PS, et al. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG. 2016;123(3):439–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Timmerman D, Deprest J, Bourne T, Van den Berghe I, Collins WP, Vergote I. A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen. Am J Obstet Gynecol. 1998;179(1):62–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Love CD, Muir BB, Scrimgeour JB, Leonard RC, Dillon P, Dixon JM. Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening. J Clin Oncol. 1999;17(7):2050–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Epstein E, Valentin L. Managing women with post-menopausal bleeding. Best Pract Res Clin Obstet Gynaecol. 2004;18(1):125–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG. 2002;109(3):313–21.CrossRefPubMedGoogle Scholar
  15. 15.
    Marchetti M, Litta P, Lanza P, Lauri F, Pozzan C. The role of hysteroscopy in early diagnosis of endometrial cancer. Eur J Gynaecol Oncol. 2002;23(2):151–3.PubMedGoogle Scholar
  16. 16.
    Visser NC, Sparidaens EM, van den Brink JW, Breijer MC, Boss EA, Veersema S, et al. Long-term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy. Acta Obstet Gynecol Scand. 2016;95(12):1418–24.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Smith PP, O'Connor S, Gupta J, Clark TJ. Recurrent postmenopausal bleeding: a prospective cohort study. J Minim Invasive Gynecol. 2014;21(5):799–803.CrossRefPubMedGoogle Scholar
  18. 18.
    Seckin B, Cicek MN, Dikmen AU, Bostanci EI, Muftuoglu KH. Diagnostic value of sonography for detecting endometrial pathologies in postmenopausal women with and without bleeding. J Clin Ultrasound. 2016;44(6):339–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Jokubkiene L, Sladkevicius P, Valentin L. Transvaginal ultrasound examination of the endometrium in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2016;48(3):390–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2004;24(5):558–65.CrossRefPubMedGoogle Scholar
  21. 21.
    Jacobs I, Gentry-Maharaj A, Burnell M, Manchanda R, Singh N, Sharma A, et al. Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol. 2011;12(1):38–48.CrossRefPubMedGoogle Scholar
  22. 22.
    Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–303.CrossRefPubMedGoogle Scholar
  23. 23.
    Terada KY, Elia J, Kim R, Carney M, Ahn HJ. Abnormal CA-125 levels in menopausal women without ovarian cancer. Gynecol Oncol. 2014;135(1):34–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Croydon University HospitalLondonUK

Personalised recommendations