Ovarian · Vulval · Vaginal Cancer & GTN Index
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
Admission triage and treatment-specific handover for oncology modules. Definitive cancer-treatment discharge criteria and systemic-therapy orders remain the responsibility of the treating MDT; this is not a chemotherapy protocol.
When admission or continued hospital care is needed
- Major bleeding, bowel/urinary obstruction, uncontrolled pain, dehydration, VTE, sepsis or an unwell patient receiving anticancer therapy needs urgent hospital assessment.
- Suspected neutropenic sepsis is an emergency; only a specialist risk-assessed pathway can support later outpatient care.
When clinic, day care or home care may be suitable
- A stable suspected/diagnosed malignancy does not automatically require emergency admission. Arrange an urgent named gynaecological-oncology/MDT pathway and track tissue/imaging results.
Before going home
- The acute problem is controlled and the treating team has agreed treatment-specific discharge criteria; oral intake, pain, mobility and any wound/drain/stoma/catheter plan are feasible.
- The patient has the cancer-team emergency contact and a named owner/date for pathology, staging and the next treatment decision.
Discharge medicines and treatment changes
- Reconcile analgesia, anticoagulation, supportive and any antimicrobial treatment with the oncology team. Chemotherapy/hormonal anticancer prescriptions are specialist- and regimen-specific.
Tests, pending results and their reviewer
- List pathology, imaging, blood/organ-function results and outstanding investigations, with the MDT/clinician responsible for acting on them.
Home care and counselling
- Teach care of any wound/drain/stoma/catheter; discuss nutrition, function, fertility/sexual health and emotional/practical support according to the actual treatment.
- For a trophoblastic diagnosis, use the histology-specific hCG surveillance plan; ovarian/vulval/vaginal treatment needs its own operative/oncology plan.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before leaving | Provide the booked oncology/MDT-result review and procedure/device appointments. |
During anticancer treatment | Follow the regimen-specific blood tests and 24-hour unwell/fever contact instructions; do not wait for routine review when ill. |
Return urgently
- Fever/rigors or feeling acutely unwell during anticancer treatment, heavy bleeding, inability to pass urine/stool with pain/vomiting, chest symptoms or collapse needs immediate assessment.
Treatment
① Immediate stabilization — first minutes
- Torsion/bleeding from masses -> emergency surgical pathways first
③ First-line treatment & drug regimens
| Disease | Core pathway |
|---|---|
Suspected ovarian carcinoma | CA125/HE4 RMI -> CT -> gynae-oncology centre upfront debulking OR neoadjuvant chemo per decision; BRCA/HRD testing informs PARP maintenance era |
Vulval carcinoma | Biopsy -> wide local excision with groin-node protocol (sentinel-node for selected) ± radiotherapy |
Vaginal carcinoma | Rare - stage-based radiotherapy±surgery at centres |
GTN (post-mole or non-molar) | hCG criteria diagnosis -> FIGO score -> single-agent MTX/actinomycin low-risk; EMA-CO high-risk; ALL at trophoblastic centres |
Definitive treatment
Centre-specific protocols; this app intentionally does NOT reproduce chemotherapy dose details without verified source documents.
Monitoring
- Tumour-marker schedules per disease; survivorship plans
⑮ Complications & their management
Bowel obstruction advanced ovarian ca
Palliative pathways: decompression/stents/symptom care discussions
Post-treatment care
- Genetic counselling referrals (BRCA/HBOC); lymphoedema services; sexual-health support
Diagnosis & assessment
Sources (8)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendation page read for postmenopausal bleeding, cervical/ovarian/endometrial concern and referral/result follow-through. Supports triage/referral only; it does not supply chemotherapy or tumour-specific postoperative discharge regimens.
· checked 2026-10-18 · verified-live
Open source ↗
Primary recommendations read: unwell patients receiving anticancer treatment need immediate assessment and suspected neutropenic sepsis is an acute emergency; only a trained specialist using an appropriate risk assessment selects outpatient care.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.