Wife gynae referral advice

[Michelangelo1975]

Hi everyone.

My Mrs had a well woman GP nurse appt in March as she was getting menopause symptoms. Nurse did smear & found what she said was a polyp & said "nothing to worry about but you'll need it looked at". Bloods taken.

Month on wife hears nothing apart from normal smear result. Calls surgery end Apr & told bloods fine and... Oh... Yeah we needed to follow that polyp up.

Then gets a letter from NHS saying we're looking at your referral, contact us after end of June if heard nothing.

Last week phone call from Gynae saying appointment this Thu.

Today letter from gynae saying its a 2 week urgent referral to rule out cancer!

Whaaaaaaat?

1. Nurse said nothing to worry about.
2. She was seen about 6 weeks back so it ain't really a 2 week referral...

Needless to say we're worried sick. Anyone ever seen this happen?

Thanks for any wisdom my head is all over place. Guess we'll see what fate brings on Thu.

That’s terrible I’m so sorry! Hopefully it’s nothing to worry about, but that doesn’t make the wait any easier to bear.

I had a referral during the first lockdown and was pleasantly surprised by the two week thing, all done and dusted within 10 days. The fact that they’ve suddenly got all urgent after keeping her waiting this long is just appalling.

Yeah it's just freaked us out.

She's now worrying as remembered "nurse being flustered" but surely it would be hugely unethical to say "nothing to worry about" if you'd seen something nasty. Then hugely shit to just not action a referral.

There must be something in the notes to warrant it, so why didn't she leave the surgery knowing that, and why has it taken since March if it is a genuine red flag?

I don't know if I'm worried or livid.

Called surgery yesterday asking for clarity & they said "there is a note on the referral but I can't access it".

Polyps on cervix are really common and not worrying. Normal smear result also hugely reassuring. My best guess would be mixed messages -someone else was asked to make the referral by the nurse (most places referral has to come from a GP or Advanced Nurse Practitioner
not from Practice Nurses) and they have misunderstood the urgency.

(or possibly they didn’t send the referral when the originally meant to and are trying to make up for it by making it more urgent).

1. Polyps are very common, I’ve had many.
2. They can turn cancerous if left untreated, but usually don’t.
3. They will probably remove it as an precaution and then send it for analysis to see if it has any pre-cancer cells. If it does have pre-cancerous cells that does not mean your wife has cancer, it means she could have developed cancer if it wasn’t removed and should monitor herself more often.
4. Nurses are ok at basic procedures but are not qualified to say “nothing to worry about” and absolutely they often do prioritise soothing the patient over giving accurate advice. I’ve had nurses tell me complete nonsense.
5. The NHS is broken and even if it wasn’t it has always been shit at gynaecology. Women’s health isn’t even compulsory at medical college and most doctors know little about it. Get your wife to a private consultant asap if you can afford it.

I think there's 2 possibilities here.

1. The referral wasn't done after the first appt in March when it should have, but was instead done end of April when the blood result conversation acted as a reminder. So the person doing it has put it down as 2 week wait to try and mitigate the delay already caused unnecessarily. This should be easy to find out by asking the surgery what date the referral was sent.

1. The referral was sent correctly as routine by the surgery, but the gynae department at the hospital have triaged it as more urgent. This may be because they have some policy of always seeing polyps as 2 week wait which the surgery might not be aware of, or the information given made them worry. It may be the lack of information is what has caused worry; a referral written by someone inexperienced saying just 'lump at cervix' might well trigger 2ww as it could be anything from a benign polyp to cancer.

Understandably worrying for you both but at least she's going to be seen soon and then you'll know what's going on.

Not sure it's fair for @Neverreturntoathread to make out this is the fault of doctors when it's clear your wife saw a nurse. If the nurse wasn't sure what she was looking at she could've asked a doctor to look or for your wife to book a separate appointment for examination. Obstetrics and gynaecology certainly is compulsory at medical schools in the UK. I agree that many doctors are still poor at it though unfortunately.

I got told last week I have polyps and need to get them checked out. They said they're nothing to worry about and they look ok, but there's a small chance they could be cancerous or turn cancerous in the future - so they need to be properly checked.

Thanks everyone.

I also understand that for an urgent referral, a requirement is that "the patient is made aware of the reason for the urgent pathway".

We have "yeah seen polyp but nothing to worry about" followed by a letter that says "exclude possibility of cancer" on it.

We'll see tomorrow I guess. I'm worse than her at this. I'm genuinely all over the shop & she's OK.

She's had all sorts of symptoms (heavy period bleeding etc) but I'd say all for at least a year. Some back pain but she's had that on & off since she broke her back & pelvis 3 years back.

The nurse who saw her initially said that wife would probably have to go back in to be seen by a more experienced practice nurse.

So referral has likely been done based on a "what did you see?" conversation between those two. Hopefully that implies a safety first approach, especially if chat was a few weeks late.

Tell you what mind, there'll be hell on if anything found that could've been better dealt with a month ago. (no idea how much that matters)

Is your wife having other symptoms such as pain or bleeding after sex, irregular bleeding, unusual discharge or a heavy feeling?

If the only indication is that the nurse has seen a polyp then they are doing the right thing in referring her to gynae (presumably for a colposcopy) so they can look in more detail. I think a PP was correct, the referral went in as a non cancer referral but the trust could well have a protocol for more urgent reviews for certain types of issues.

Cervical and vaginal cancers are usually very slow growing so the wait of 6 weeks is nothing but the wait is the longest time in the world.

And to @Neverreturntoathread My various oncologists and surgeons all work in both NHS and private practice and the care and treatment is exactly the same.

She's had missed periods then had super heavy ones. Seemed to go through a really inconsistent patch last year now seems more regular. Had some clear discharge. Bit of tiredness over past 6-12 months but then she'll be riding her exercise bike next day.

Back pain but like I say she broke it 3 years back & pelvis same.

Appt is ultrasound followed by gynae consultation.

I have been through this for a different gynae issue (very heavy bleed out of the blue, possible fibroid seen on a prior scan) The consultant terrified me when he said my GP had referred me to rule out cancer, as there had been no mention of that before and the new scan showed nothing unusual, the suspect fibroid was in fact scar tissue from my c-section.
I think it sounds like a miscommunication, or just being thorough, so try not to panic.

Thanks all for helpful replies.

Glass of wine tonight to steady the nerves & then we get my precious Mrs in there tomorrow. 🤞

@Michelangelo1975 The 2-week pathway is just a 'normal' (generic) letter that goes out to anyone with anything that needs looking at. Don't take it too literally.

It's the same letter than women get for any abnormal bleeding etc.

Cervical polyps are very common. They may remove it or not. They rarely turn cancerous. They either are or they are not. They tend to remove them on the cervix as they can bleed when bumped.

Please don't worry. A huge number of women have polyps and they are hardly ever malignant.

Thanks everyone.

She was seen today & thank god it is a case of quite complex polyps. One cervical & one in uterus. She needs an op in June under general anaesthetic to remove em.
But after a scan & consultant check they weren't too concerned. They just want them out & checked.

So we're both relieved.

Thanks for all the useful posts. Hugely appreciated.

Hugs 🫂 to you and your wife. Its absolutely terrifying to see that word in a letter referring to someone you love. The tests are probably to exclude
possibilities rather than to confirm them. Best wishes for tomorrow. 💐