Standards for the management of cervical and vulval carcinoma

Objective To examine the feasibility of achieving designated target standar ds for the management of women with cervical and vulval cancer. Design Retrospective casenote review. Setting The Gynaecological Oncology Centre at Hammersmith Hospital, London. Population Sixty-one women with cervical and vulval cancer presenting to th e gynaecological oncology clinic at the Hammersmith Hospital during 1996 an d 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance. Results The target interval of seven days between receipt of the referral a nd the first visit at the cancer centre was achieved in 93% of women. Surgi cal treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involvin g the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic a nd 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 ou t of 22 (23%) of vulval cancers. Conclusion The suggested targets of process and surgical performance are re asonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in e ach patient's notes and available at specialist clinics and gynaecology war ds.