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Year 4 - 4. Cancer Care > Screening / referral guidelines > Flashcards

Screening / referral guidelines Flashcards

1
Q

State red flag symptoms for laryngeal cancer - which warrants an urgent referral 2WW

A

For patients aged > 45

Persistent, unexplained hoarseness of voice

OR

Unexplained lump in the neck

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2
Q

State red flag symptoms for oral cancer - which warrants an urgent referral 2WW

A

No age specified

Unexplained ulceration in the oral cavity lasting > 3 weeks

OR

Persistent, unexplained lump in the neck

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3
Q

State red flag symptoms for thyroid cancer - which warrants an urgent referral 2WW

A

No age specified

Any unexplained thyroid lump

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4
Q

State red flag symptoms for malignant melanoma - which warrants an urgent referral 2WW

A

No age specified

Suspicious pigmented skin lesion with score of 3 or more (on 7-point weighted checklist)

OR

Dermoscopy which suggests malignant melanoma

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5
Q

State red flag symptoms for squamous cell carcinoma - which warrants an urgent referral 2WW

A

No age specified

Any skin lesion suspicious of squamous cell carcinoma
- Raised
- Ulcerated / keratinised / crusting
- Typically head/neck, back of hand

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6
Q

State red flag symptoms for basal cell carcinoma - which warrants an urgent referral 2WW

A

No age specified

ONLY consider if skin lesion suspicious of BCC and delay may have an unfavourable outcome e.g. location or size of lesion

Features:
- Waxy / pearly in appearance
- Raised, rolled edge
- Prominent fine blood vessels around lesion

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7
Q

State red flag symptoms for prostate cancer - which warrants an urgent referral 2WW (and which symptoms warrant a non-urgent referral)

A

No age range specified

PSA levels above age-range

OR

Prostate feels malignant on DRE

**Non-urgent referral if following:
- LUTS symptoms
- Erectile dysfunction
- Visible haematuria

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8
Q

State red flag symptoms for bladder cancer - which warrants an urgent referral 2WW (and which symptoms warrant a non-urgent referral)

A

Aged 45 or over with:

Unexplained visible haematuria (not UTI)
OR
Visible haematuria persisting despite UTI treatment

Aged 60 or over with:

Unexplained non-visible haematuria with either 1) dysuria 2) raised WCC

**Non-urgent referral if recurrent / persistent UTI

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9
Q

State red flag symptoms for renal cancer - which warrants an urgent referral 2WW

A

For patients aged > 45

Unexplained visible haematuria (not UTI)

OR

Visible haematuria persisting after UTI treatment

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10
Q

State red flag symptoms for testicular cancer - which warrants an urgent referral 2WW

A

Any male with the following changes to testicles:

Non-painful enlargement
Change in shape
Change in texture

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11
Q

State red flag symptoms for penile cancer - which warrants an urgent referral 2WW

A

Any male for which they have a negative STI screen, and the following symptoms:

Penile mass
Ulcerated lesion
Unexplained / persistent symptoms of foreskin or glans penis

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12
Q

State red flag symptoms for lung cancer - outline when urgent investigations vs urgent referral is indicated

A

Urgent investigation (urgent chest x-ray)

For patients aged > 40 with any
- Persistent / recurrent chest infection
- Finger clubbing
- Supraclavicular or persistent cervical lymphadenopathy
- Thrombocytosis
- Chest signs associated with lung cancer (never smoked, need 2 but if smoked only need 1)
Signs and symptoms:
- Cough
- Fatigue
- SOB
- Chest pain
- Weight loss / appetite loss

Do urgent referral (2WW) if
- Chest x-ray findings suggestive of cancer or mesothelioma
- Aged > 40 and unexplained haemoptysis

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13
Q

State red flag symptoms for brain / CNS cancer and when very urgent referral and urgent direct access referral are indicated

A

Very urgent referral:
- Under 24 and newly central neurological changes

Urgent direct access referral (direct access to MRI brain scan in 2 weeks)
- Progressive, sub-acute central neurological changes

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14
Q

State red flag symptoms for oesophageal cancer - which warrants an urgent referral 2WW (for endoscopy)

A

FOR ENDOSCOPY

Any age:
Dysphagia

Aged > 55 with:
Weight loss AND….
- Upper abdominal pain
- Reflux
- Dyspepsia

*non urgent direct access endoscopy for…
- Over 55 with treatment resistant dyspepsia
- Upper abdominal pain and low Hb
- Raised platelet count / N&V with OG cancer symptoms

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15
Q

State red flag symptoms for pancreatic cancer - which warrants an urgent referral 2WW vs warrants a direct access CT scan

A

2WW referral:
Aged > 40 with jaundice (painless but not specified in guidelines)

Direct access CT scan:
Aged > 60 and weight loss, AND
- Diarrhoea / constipation / N&V
- Pain (abdominal or back)
- New onset diabetes

CT is more appropriate as ultrasound can miss 10% of pancreatic cancers

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16
Q

State red flag symptoms for gall bladder cancer - which warrants a direct access ultrasound scan

A

Upper abdominal mass (consistent with enlarged gall bladder)

17
Q

State red flag symptoms for hepatic cancer - which warrants a direct access ultrasound scan

A

Upper abdominal mass (consistent with enlarged liver)

18
Q

State when to make the following referrals for suspected bone sarcoma
- Very urgent direct access to x-ray
- Very urgent referral
- Urgent referral

A

Very urgent direct access to x-ray:
Under 25 and bone swelling or pain

Very urgent referral:
Under 25 and suspicious x-ray

Urgent referral:
Over 25 and suspicious x-ray

19
Q

State when to make the following referrals for suspected soft tissue sarcoma
- Very urgent direct access to USS
- Urgent direct access to USS
- Very urgent referral
- Urgent referral

A

Very urgent direct access to USS:
- Under 25 with lump increasing in size

Urgent direct access to USS:
- Adults with lump increasing in size

Very urgent referral:
- Under 25 with USS findings with changes suggestive of sarcoma or uncertain

Urgent referral:
- Adults with USS findings with changes suggestive of sarcoma or uncertain

20
Q

State red flag symptoms for breast cancer - which warrants an urgent referral 2WW vs non-urgent referral

A

Aged > 30 with an unexplained breast / axilla lump (+/- pain)

Aged > 0 with unilateral nipple changes

Any age with skin changes suggestive of breast cancer

Non-urgent referral:
Aged < 30 with an unexplained breast lump (+/- pain)

21
Q

State red flag symptoms for suspected leukaemia - which warrants an very urgent investigation (specialist assessment) vs very urgent blood counts (within 48 hrs)

A

Very urgent investigation (specialist assessment):
Unexplained petechiae
OR
Hepatosplenomegaly

Very urgent blood counts (within 48 hrs) if any of the following:
- Generalised lymphadenopathy
- Bruising / bleeding
- Pallor
- Persistent fatigue
- Fever
- Persistent or recurrent infection

22
Q

State red flag symptoms for suspected lymphoma - which warrants immediate specialist assessment vs urgent referral

A

Immediate specialist assessment:
Under 25 with unexplained lymphadenopathy OR splenomegaly

Urgent referral:
Adults with unexplained lymphadenopathy OR splenomegaly

23
Q

State red flag symptoms for suspected myeloma- which warrants an urgent investigation (further bloods) vs very urgent protein electrophoresis and Bence-Jones protein urine test (within 48 hrs)

A

Urgent investigation (further bloods):
Aged > 60 and persistent pain OR unexplained fracture

Very urgent protein electrophoresis and Bence-Jones protein urine test (within 48 hrs)
Aged > 60 and hypercalcaemia / leukopenia AND suspicious clinical presentation
Any age with plasma viscosity / raised ESR

24
Q

State red flag symptoms for ovarian cancer - which warrants urgent referral vs urgent investigations (Ca125 +/- USS)

A

Urgent referral:
- Ascites
- Abdominal mass (non-fibroid)

Urgent investigations (Ca125 +/- USS):
Aged > 50 with frequent symptoms
- Abdominal pain
- Bloating
- Urine frequency or urgency
- New IBS symptoms
- Unexplained weight loss / fatigue / changes in bowel habit (colorectal cancer more likely)

25
Q

State red flag symptoms for endometrial cancer - which warrants urgent referral vs direct access USS

A

Urgent referral:
- Aged > 55 with postmenopausal bleeding

Direct access USS:
- Vaginal discharge with thrombocytosis OR haematuria
- Visible haematuria with thrombocytopenia / hyperglycaemia / low Hb

26
Q

State red flag symptoms for cervical cancer - which warrants 2WW urgent referral

A

Visual changes to cervix (consistent with cervical cancer)

**NOTE previous negative smear test should not deter referral

27
Q

State red flag symptoms for vulvar cancer - which warrants 2WW urgent referral

A

Any women with unexplained vulvar lump, ulceration or bleeding

28
Q

State red flag symptoms for vaginal cancer - which warrants 2WW urgent referral

A

Any women with unexplained palpable vaginal lump in or at the entrance to the vagina

29
Q

State red flag symptoms for colorectal cancer - which warrants 2WW urgent referral

A

Recent positive FIT testing

Aged > 40 with unexplained weight loss AND abdominal pain

Aged > 50 with unexplained rectal bleeding

Aged > 60 with iron deficiency anaemia OR altered bowel habit

Consider urgent referral 2WW if:
Any age with a rectal or abdominal mass
Aged <50 with rectal bleeding AND
– abdominal pain
– altered bowel habit
– weight loss
– iron deficiency anaemia

30
Q

State red flag symptoms for anal cancer - which warrants 2WW urgent referral

A

Unexplained anal mass OR ulcercation

31
Q

Briefly explain the concept of cancer screening and some advantages and disadvantages

A

Screening aims to find cancer or precancerous changes early, leading to improved outcomes form early intervention

Advantages:
- Improved survival rates
- If found earlier, may need less treatment or less intensive treatment

Disadvantages:
- False positive = make you think you have cancer when you don’t
- May require more invasive tests (have their own side effects)
- False negative = falsely reassure you that there isn’t a cancer but it’s been missed
- May find a cancer that would have caused the patient no issues / wouldn’t have shortened their life e.g. prostate cancer

32
Q

Describe breast cancer screening as if you are explaining it to a patient

A

Breast cancer screening involves mammograms (low-dose x-ray of the breast)
Aims to find signs of early breast cancers that are too small to see or feel
For women aged between 50-70

Advantages:
- Doesn’t prevent breast cancer, but it does reduce the number of deaths from breast cancer each year, treatment is more likely to be effective and less treatment may be needed

Negatives:
- False positive = may require further testing
- False negative = may be falsely reassured
- Further investigations can be more invasive and own side-effects

33
Q

State the aspects of health that should be covered in a cancer history

A
  • Physical health
  • Psychological health
  • Spirituality
  • Social factors / impact
34
Q

List some of the adult UK screening programmes

A
  • AAA
  • Bowel
  • Breast
  • Cervical
  • Diabetic Eye

Year 4 - 4. Cancer Care (9 decks)

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