Suspected cancer (recognition and referral) Flashcards
How long should a patient with suspected cancer wait before they are seen by a specialist?
Within 2 weeks
What should be done for patients with suspected lung cancer?
Order an urgent CXR (within 2 weeks) to assess lung cancer (same for mesothelioma) in people aged 40 or over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms: cough fatigue shortness of breath chest pain weight loss appetite loss. Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following: persistent or recurrent chest infection finger clubbing supraclavicular lymphadenopathy or persistent cervical lymphadenopathy chest signs consistent with lung cancer thrombocytosis.
What should be done for patients with suspected oesophageal cancer?
Offer urgent direct access to upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people:
with dysphagia or
aged 55 and over with weight loss and any of the following:
upper abdominal pain
reflux
dyspepsia.
Consider non-urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people with haematemesis.
What should be done for patients with suspected bowel cancer?
-Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
they are aged 40 and over with unexplained weight loss and abdominal pain or
they are aged 50 and over with unexplained rectal bleeding or
they are aged 60 and over with:
iron-deficiency anaemia or
changes in their bowel habit, or
tests show occult blood in their faeces.
-Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
abdominal pain
change in bowel habit
weight loss
iron-deficiency anaemia.
What should be done for patients with suspected prostate cancer?
Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination.
Consider a prostate-specific antigen test and digital rectal examination to assess for prostate cancer in men with:
any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
erectile dysfunction or
visible haematuria.
What should be done for patients with suspected bladder cancer?
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:
aged 45 and over and have:
unexplained visible haematuria without urinary tract infection or
visible haematuria that persists or recurs after successful treatment of urinary tract infection, or
aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
What should be done for patients with suspected thyroid cancer?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.
What should be done for patients with suspected NHL?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for non-Hodgkin’s lymphoma in adults presenting with unexplained lymphadenopathy or splenomegaly.
When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss.
What should be done for patients with suspected HL?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for Hodgkin’s lymphoma in adults presenting with unexplained lymphadenopathy.
When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus, weight loss or alcohol-induced lymph node pain.
What should be done for patients with suspected leukaemia?
Consider a very urgent full blood count (within 48 hours) to assess for leukaemia in adults with any of the following: pallor persistent fatigue unexplained fever unexplained persistent or recurrent infection generalised lymphadenopathy unexplained bruising unexplained bleeding unexplained petechiae hepatosplenomegaly.
What should be done for patients with suspected myeloma?
Offer a full blood count, blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate to assess for myeloma in people aged 60 and over with persistent bone pain, particularly back pain, or unexplained fracture.
Offer very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours) to assess for myeloma in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma.
Consider very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours) to assess for myeloma if the plasma viscosity or erythrocyte sedimentation rate and presentation are consistent with possible myeloma.
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if the results of protein electrophoresis or a Bence-Jones protein urine test suggest myeloma.
