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How to refer a patient

I usually see new patients within 5 working days. Please feel free to discuss any urgent appointments on (07) 3128 0800.

I  see patients on Wednesdays at 225 Wickham Terrace, Spring Hill. Alternatively, patients can be seen at Kawana on alternate Friday mornings. Patients seen on Friday mornings cannot have surgery on the same afternoon as they require time to consider treatment options, risks and potential down sides of surgery.

All appointments are made through my Brisbane office (07) 3128 0800.

Select a referral guide:

 


Hysterectomy for abnormal uterine bleeding

  • My preferred surgical approach to hysterectomy is a laparoscopic hysterectomy(for alternatives to hysterectomy look here). 
  • Previous abdominal/pelvic surgery (including caesarean sections) typically is not a contraindication for laparoscopic hysterectomy.
  • If the patient has a significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about those conditions.
  • Patients should be off any blood thinning medication (including herbs and supplements) for at least 1 week prior to surgery.
  • All patients require a pelvic ultrasound. I will arrange all other tests if necessary.

Ovarian cancer (ascites, omental masses)

  • Prior to initial consultation all patients require a CT scan of the pelvis, abdomen and chest. This can be arranged through my staff at my office.
  • Patients require tumour markers CA125, CA 19.9 and CEA. Please copy me into those results. If the CEA is markedly elevated I will request a colonoscopy to exclude a colorectal primary tumour.
  • Patients should be off any blood thinning medication (including herbs and supplements) for at least one week prior to surgery.
  • If the patient has a significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about those conditions.
  • Ovarian cancer surgery will only be performed at St Andrews Hospital (private), Greenslopes Private Hospital (private) or RBWH (public).
  • All major ovarian cancer surgery is open through laparotomy.

Suspicious pelvic masses/cysts

  • Prior to initial consultation all patients require an Ultrasound (transvaginal preferred).
  • A CT scan of the pelvis, abdomen and chest is needed if the mass is solid or complex (solid + cystic). This can be arranged through my office in Spring Hill.
  • Do not request imaging-guided cyst drainage. It could burst a tumour.
  • Patients require tumour markers CA125, HE4, CA 19.9 and CEA. Please copy me into those results. If the CEA is markedly elevated I will request a colonoscopy to exclude a colorectal primary tumour.
  • Patients should be off any blood thinning medication (including herbs and supplements) for at least one week prior to surgery.
  • If the patient has a significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about those conditions.
  • Laparoscopic surgery is my preferred surgical approach. However, some patients will require a laparotomy for surgical exploration.

Abnormal PAP smear

  • Possible Low-grade squamous abnormality: Repeat PAP in 12 months. If still abnormal, refer for colposcopy; if normal at 12 months, continue with PAP every 2 years.
  • Low grade squamous abnormality: Repeat PAP in 12 months. If still abnormal, refer for colposcopy; if normal at 12 months, continue with PAP every 2 years.
  • Possible high grade squamous abnormality: Refer for colposcopy
  • High grade squamous abnormality: Refer for colposcopy
  • Adenocarcinoma in-situ (?ACIS): Refer for colposcopy
  • Adenocarcinoma in-situ (ACIS): Refer for colposcopy
  • Adenocarcinoma: Refer for colposcopy

Cervical cancer

  • All patients with lesions on the cervix require a cervical biopsy (please copy me into the histopathology report)
  • Patients with histologically confirmed cervical cancer require a PET-CT scan and patients with locally advanced cervical cancer require an MRI scan of pelvis (requires specialist referral; I will organise)
  • If the patient has a significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about medical conditions.

Postmenopausal bleeding

All postmenopausal bleeding in women who are not on HRT needs to be investigated:

  • Patients with risk factors (abnormal endometrial cells on PAP; history of breast or bowel cancer, suspicious lesion on pelvic ultrasound): refer straight to gynaecological oncologist
  • Patients without risk factors and premenopausal women: Refer to general gynaecologist

Postmenopausal women:

  • Exclude cervical/vaginal pathology (Pelvic vaginal examination, PAP smear)
  • Full blood count if bleeding is significant
  • Transvaginal ultrasound
  • Refer for endometrial sampling or hysteroscopy D&C

Pre- and perimenopausal women:

  • Exclude cervical/vaginal pathology (PVE, PAP smear)
  • Exclude pregnancy
  • Refer for colposcopy to general gynaecologist if postcoital bleeding
  • Full blood count if bleeding is significant
  • Transvaginal ultrasound
  • Refer for endometrial sampling or hysteroscopy D&C to general gynaecologist

Endometrial cancer

  • Please attach the histopathological report from the curette/Pipelle to your referral.
  • Prior to initial consultation patients require a CT scan of the pelvis, abdomen and chest. This can be arranged through my office in Spring Hill.
  • Patients require a tumour marker CA125 and HE4. Please copy me into those results.
  • Patients should be off any blood thinning medication (including herbs and supplements) for at least 1 week.
  • If the patient has significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about those conditions.

Vulval mass/lesion

  • All patients with obvious lesions on vulva require a punch biopsy (please copy me into the histopathology report). I am also happy to do the biopsy.
  • Patients with histologically confirmed vulval cancer require a CT scan of pelvis, abdomen and chest; I am happy to arrange through my office.
  • If the patient has a significant medical history, please contact my office prior to the initial appointment. We appreciate any correspondence about those conditions.

Strong Family History of breast and ovarian cancer

Patients with a strong family history of breast and/or ovarian cancer might benefit from BRAC1/2 testing (blood test).

Patients who are negative for BRCA1/2 have the “normal” risk of breast and ovarian cancer similar to the general population. The only exemption would be if patients carry a mutation that has not been described in the world-literature yet.

Patients who are positive for BRCA1/2 mutations will benefit from prophylactic, risk-reducing bilateral salpingo-oophorectomy (BSO) with or without a hysterectomy. All prophylactic surgery (including hysterectomy) should be performed laparoscopically. Laparotomies are to be avoided.


Strong Family History of bowel and uterine cancer

Typically, a screening diagnosis of Lynch Syndrome is made on a pathology specimen after surgery for bowel or uterine cancer. Confirmation of Lynch Syndrome requires a blood test.

Patients who are negative for Lynch Syndrome/2 have the “normal” risk of uterine and bowel cancer similar to the general population. The only exemption would be if patients carry a specific mutation that has not been described in the world-literature yet.

Patients with Lynch syndrome benefit from prophylactic, risk-reducing removal of uterus, tubes and ovaries. Prophylactic surgery (including hysterectomy) should always be laparoscopic. Laparotomies are to be avoided.