2-Week Cancer Pathways Flashcards
2-week cancer pathway - Brain and CNS Tumours? Children?
MRI Scan (CT if MRI CI) in adults with progressive, sub-acute loss of central neurological function
In children - appointment within 48 hours
2-week cancer pathway - Breast Cancer?
Appointment if:
> 30 and have unexplained breast lump
> 50 with discharge/retraction/other changes of concern in one nipple only
2-week cancer pathway - Oesophageal & Gastric Cancer?
Upper GI endoscopy if:
Dysphagia
> 55 with weight loss and any of - upper abdominal pain, reflux or dyspepsia
2-week cancer pathway - When to consider oesophageal & Gastric referral?
> 55 with:
Treatment resistant dyspepsia
Upper abdominal pain with low Hb
Raised platelet count with any of - nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
N&V with any of - weight loss, reflux, dyspepsia, upper abdominal pain
2-week cancer pathway - Pancreatic Cancer? When to consider?
> 40 and have jaundice
Consider >60 with weight loss and any of - diarrhoea, back pain, abdominal pain, N&V, constipation, new-onset diabetes
2-week cancer pathway - Gallbladder Cancer?
Consider US if upper abdominal mass consistent of enlarged gall bladder
2-week cancer pathway - Liver Cancer?
Consider US if upper abdominal mass with enlarged liver
2-week cancer pathway - colorectal cancer?
> 40 with unexplained weight loss and abdominal pain
> 50 with unexplained rectal bleeding
> 60 with iron-deficiency anaemia or changes in bowel habit
Positive faecal occult blood
2-week cancer pathway - Anal Cancer?
Unexplained anal mass or ulceration
2-week cancer pathway - Ovarian Cancer?
Ascites and/or pelvic or abdominal mass (not uterine fibroids)
2-week cancer pathway - Endometrial Cancer?
> 55 with post-menopausal bleeding
Consider if <55 with PMB
2-week cancer pathway - when to consider US in endometrial cancer?
> 55 and:
Unexplained symptoms of vaginal discharge - presenting for 1st time, thrombocytosis, haematuria
Visible haematuria and - low Hb, thrombocytosis, high blood glucose
2-week cancer pathway - Cervical Cancer?
Cervix on examination consistent with cancer
2-week cancer pathway - Vulval Cancer?
Unexplained vulval lump, ulceration or bleeeding
2-week cancer pathway - Vaginal Cancer?
Unexplained palpable mass in or at entrance to vagina
2-week cancer pathway - Leukaemia? Children?
Very urgent FBC (within 48 hours) if:
Pallor Persistent fatigue Unexplained fever Unexplained recurrent infection Lymphadenopathy Unexplained bleeding, bruising, petechiae Hepatosplenomegaly
Children - Immediate specialist assessment if unexplained petechiae or hepatosplenomegaly
2-week cancer pathway - Myeloma?
> 60 with persistent bone pain (particularly back) or unexplained fracture - FBC, Ca, plasma viscosity or ESR
> 60 with hypercalcaemia or leukopenia and presentation consistent of myeloma - within 48 hours protein electrophoresis and Bence-Jones protein urine test
Consider within 48 hours protein electrophoresis and Bence-Jones protein urine test if plasma viscosity or ESR and presentation consistent with myeloma
Refer if results of protein eletrophoresis or Bence-Jones protein urine test suggest myeloma
2-week cancer pathway - Lymphomas?
Refer if unexplained lymphadenopathy or splenomegaly (NHL)
Children - within 48 hours
2-week cancer pathway - Laryngeal cancer?
> 45 with:
Persistent unexplained hoarseness
Unexplained lump in neck
2-week cancer pathway - oral cancers?
Unexplained ulceration in oral cavity >3 weeks or
Persistent and unexplained lump in neck
2-week cancer pathway - Thyroid Cancer?
Unexplained thyroid lump
2-week cancer pathway - Lung Cancer?
Appointment - CXR findings of lung cancer OR >40 with unexplained haemoptysis
CXR - >40 if 2 or more (1 or more if ever smoked):
Cough, fatigue, SOB, chest pain, weight loss, appetite loss
Consider if persistent or recurrent infections, finger clubbing, cervical/supraclavicular lymphadenopathy, chest signs, thrombocytosis
2-week cancer pathway - Bone sarcoma?
XR suggests bone sarcoma
Child - within 48 hours
2-week cancer pathway - Soft tissue sarcoma?
US if unexplained lump increasing in size
Child - within 48 hours
2-week cancer pathway - Malignant Melanoma?
Weight 7-point checklist of 3 or more:
Major (2 points) - change in size, irregular shape, irregular colour
Minor (1 point) - diameter >7mm, inflammation, oozing, change in sensation
2-week cancer pathway - BCC/SCC of skin?
SCC - 2 week referral if skin lesion suspicious of SCC
BCC - routine referral if lesion suspicious of BCC, only consider 2 week if concern that delay may have significant impact (site or size)
2-week cancer pathway - Prostate Cancer?
Refer if PSA high or Prostate feels malignant on DRE
Perform PSA and DRE if:
Any LUT symptoms (nocturia, urinary frequency, hesitancy, urgency, retention), erectile dysfunction, visible haematuria
2-week cancer pathway - Bladder Cancer?
> 45 with:
Unexplained visible haematuria without UTI
Visible haematuria persisting or recurring after treatment of UTI
> 60 with unexplained non-visible haematuria and either dysuria or raised WCC
2-week cancer pathway - Renal Cancer?
> 45 with:
Unexplained visible haematuria without UTI
Visible haematuria persisting or recurring after treatment of UTI
2-week cancer pathway - Testicular Cancer?
Appointment - non-painful enlargement or change in shape or texture of testis
US - unexplained or persistent testicular symptoms
2-week cancer pathway - Penile Cancer?
Penile mass or ulcerated lesion, where STI excluded
Persistent penile lesion after STI treated
2-week cancer pathway - Child neuroblastoma?
Appointment within 48 hours with palpable abdominal mass or unexplained enlarged abdominal organ
2-week cancer pathway - Child retinoblastoma?
2-week referral in child with absent red reflex
2-week cancer pathway - child Wilm’s Tumour?
Appointment within 48 hours if:
Palpable abdominal mass
Unexplained enlarged abdominal organ
Unexplained visible haematuria
