Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Deliver risk-stratified gynaecological cancer follow-up that detects concerning symptoms promptly while actively treating lymphoedema, late toxicity, menopause, sexual, psychological and rehabilitation needs.
Gynaecological cancer follow-up is not a uniform calendar of scans. Its purpose is to give rapid access for possible recurrence, detect selected recurrence when earlier intervention can help, manage treatment effects and rebuild health and function. At completion of surgery, radiotherapy or systemic treatment, provide a treatment summary to the patient and primary care team. It should identify tumour site, histology, stage and relevant biomarkers, treatment dates and fields, important complications, current medicines, the follow-up route, recurrence symptoms and who to contact without waiting for a routine appointment.
Stratify the pathway by recurrence risk, treatment and ability to self-manage. A person with low-grade, early disease fully treated by surgery may be suitable for supported patient-initiated follow-up with annual reminders and direct clinical nurse specialist access. Someone with higher-risk histology, advanced disease, fertility-sparing treatment, unresolved toxicity or active maintenance therapy requires scheduled specialist review and protocol-led tests. Patient-initiated follow-up is an organised service with education and access, not discharge without a safety net.
New vaginal or vulval bleeding, contact bleeding, blood-stained discharge, pelvic pain or a lesion warrants prompt examination and tissue or imaging assessment.
Persistent cough, breathlessness, weight loss, bone pain, neurological symptoms, abdominal distension or declining function redirects follow-up toward systemic staging.
Intermittent heaviness, sock indentation, tight clothing, genital fullness or asymmetry after nodal treatment can precede fixed visible swelling.
Persistent limb or genital enlargement with pitting, skin thickening, reduced flexibility and recurrent cellulitis supports chronic secondary lymphatic dysfunction.
Urinary frequency, haematuria, bowel urgency, rectal bleeding, dyspareunia or pelvic pain may reflect treatment injury but still requires exclusion of recurrence and other disease.
Supported patient-initiated follow-up can be safe only when education, reminders and rapid specialist review genuinely remain available.
A tumour marker may support a site-specific protocol, but a reassuring number cannot veto concerning symptoms or examination findings.
Cancer-related lymphoedema is common after nodal treatment, yet thrombosis, cellulitis, recurrence and organ failure may be more urgent explanations.
Garment pressure, shape and application must match vascular safety, anatomy, tissue status, dexterity and the reduction or maintenance phase.
Bowel, bladder, sexual, menopausal and fatigue problems should trigger rehabilitation and specialist care rather than being accepted as the inevitable price of cure.
Calling patient-initiated follow-up a discharge while failing to provide education, annual contact or a functioning rapid-access route.
Ordering routine scans or tumour markers without a cancer-specific indication and then overlooking symptoms because those tests appear reassuring.
Attributing sudden unilateral leg swelling to chronic lymphoedema before excluding venous thromboembolism or malignant obstruction.
Applying compression to an acutely painful, erythematous or vascularly compromised limb without appropriate clinical assessment.
Normalising persistent urinary, bowel, sexual or pain symptoms as inevitable treatment effects without investigating recurrence and offering rehabilitation.
Delaying cellulitis treatment in a lymphoedematous limb until a routine lymphoedema appointment.
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A patient on supported patient-initiated follow-up after low-risk endometrial cancer reports new blood-stained vaginal discharge and pelvic pain lasting several days. What is the best action?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Examination and tests should follow the original cancer and current presentation. Inspect and palpate the relevant vulval, vaginal, pelvic, abdominal and nodal areas with consent when findings could change care. New symptoms may justify blood tests, pelvic imaging, CT, MRI, PET-CT, endoscopy or biopsy through the MDT. CA125 is useful in selected ovarian-cancer pathways but does not replace clinical review; routine imaging of every asymptomatic survivor can create radiation, false-positive and anxiety burdens without a clear benefit.
Late effects often cross specialties. Pelvic radiotherapy can produce vaginal stenosis, dryness, bleeding, bowel urgency, diarrhoea, proctitis, cystitis, haematuria, pelvic insufficiency fracture and premature ovarian failure. Surgery can leave urinary, bowel, nerve, stoma, hernia and sexual difficulties. Platinum and taxane treatment may cause neuropathy, hearing or renal effects, and immunotherapy can cause delayed inflammatory toxicity. Name the likely mechanism, exclude recurrence where appropriate, and refer to pelvic-health physiotherapy, gastroenterology, urology, menopause, sexual-health, pain or rehabilitation services rather than normalising disability.
Secondary lymphoedema occurs when lymphatic vessels or nodes are damaged or obstructed by nodal surgery, radiotherapy, infection or recurrent tumour. In gynaecological cancer it can involve one or both legs, lower abdomen, mons or vulva. Early symptoms include heaviness, tight clothing, altered sensation and intermittent swelling; later disease becomes persistent, fibrotic and more difficult to reverse. Compare sides, examine skin and scars, measure limb circumference or volume consistently and ask about function, pain and infection.
New swelling needs a differential diagnosis. Sudden unilateral swelling or pain requires venous-thromboembolism assessment. Erythema, heat, tenderness and systemic upset suggest cellulitis. Pelvic recurrence can obstruct lymphatic or venous flow; heart failure, renal or liver disease, medication and immobility can cause bilateral oedema. Do not apply high compression blindly when acute arterial insufficiency, untreated infection, decompensated cardiac failure or an undiagnosed acute swelling makes it unsafe; obtain appropriate vascular, medical or oncological assessment.
Decongestive lymphatic therapy is the established control strategy. Its four components are fitted compression bandaging or garments, meticulous skin care, graduated movement and exercise, and specialised manual lymphatic drainage or taught self-drainage. An intensive reduction phase may be followed by long-term maintenance with a garment, self-massage and activity. Compression needs specialist measurement and reassessment because limb shape, skin integrity, arterial supply, dexterity and comfort determine the device. Weight management and movement support function without blaming the patient for a treatment consequence.
Lymphoedematous tissue is vulnerable to cellulitis. Teach daily inspection, moisturising, prompt cleaning of skin breaks, treatment of fungal infection and urgent help for new heat, redness, tenderness, rapidly increased swelling, fever or rigors. Acute infection is treated through the local cellulitis pathway; compression may need temporary modification according to pain and specialist advice. Repeated infection warrants lymphoedema-service and antimicrobial review rather than repeated unsupervised standby courses.
Survivorship care should restore control without creating abandonment. Complete a holistic needs assessment, give a written care plan and revisit goals as work, relationships and symptoms change. Offer vaccination and general preventive care, smoking support, physical activity, nutrition and age-appropriate non-gynaecological screening. Fear of recurrence is common; validate it, provide clear symptom thresholds and use psychological support when worry becomes disabling. Early palliative-care involvement can coexist with active treatment for recurrent disease and improves symptom and decision support.