2-Week Cancer Pathways

Question 1

2-week cancer pathway - Brain and CNS Tumours? Children?

Answer 1

MRI Scan (CT if MRI CI) in adults with progressive, sub-acute loss of central neurological function

In children - appointment within 48 hours

Question 2

2-week cancer pathway - Breast Cancer?

Answer 2

Appointment if:

> 30 and have unexplained breast lump

> 50 with discharge/retraction/other changes of concern in one nipple only

Question 3

2-week cancer pathway - Oesophageal & Gastric Cancer?

Answer 3

Upper GI endoscopy if:

Dysphagia

> 55 with weight loss and any of - upper abdominal pain, reflux or dyspepsia

Question 4

2-week cancer pathway - When to consider oesophageal & Gastric referral?

Answer 4

> 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

Question 5

2-week cancer pathway - Pancreatic Cancer? When to consider?

Answer 5

> 40 and have jaundice

Consider >60 with weight loss and any of - diarrhoea, back pain, abdominal pain, N&V, constipation, new-onset diabetes

Question 6

2-week cancer pathway - Gallbladder Cancer?

Answer 6

Consider US if upper abdominal mass consistent of enlarged gall bladder

Question 7

2-week cancer pathway - Liver Cancer?

Answer 7

Consider US if upper abdominal mass with enlarged liver

Question 8

2-week cancer pathway - colorectal cancer?

Answer 8

> 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

Question 9

2-week cancer pathway - Anal Cancer?

Answer 9

Unexplained anal mass or ulceration

Question 10

2-week cancer pathway - Ovarian Cancer?

Answer 10

Ascites and/or pelvic or abdominal mass (not uterine fibroids)

Question 11

2-week cancer pathway - Endometrial Cancer?

Answer 11

> 55 with post-menopausal bleeding

Consider if <55 with PMB

Question 12

2-week cancer pathway - when to consider US in endometrial cancer?

Answer 12

> 55 and:

Unexplained symptoms of vaginal discharge - presenting for 1st time, thrombocytosis, haematuria

Visible haematuria and - low Hb, thrombocytosis, high blood glucose

Question 13

2-week cancer pathway - Cervical Cancer?

Answer 13

Cervix on examination consistent with cancer

Question 14

2-week cancer pathway - Vulval Cancer?

Answer 14

Unexplained vulval lump, ulceration or bleeeding

Question 15

2-week cancer pathway - Vaginal Cancer?

Answer 15

Unexplained palpable mass in or at entrance to vagina

Question 16

2-week cancer pathway - Leukaemia? Children?

Answer 16

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

Question 17

2-week cancer pathway - Myeloma?

Answer 17

> 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

Question 18

2-week cancer pathway - Lymphomas?

Answer 18

Refer if unexplained lymphadenopathy or splenomegaly (NHL)

Children - within 48 hours

Question 19

2-week cancer pathway - Laryngeal cancer?

Answer 19

> 45 with:

Persistent unexplained hoarseness

Unexplained lump in neck

Question 20

2-week cancer pathway - oral cancers?

Answer 20

Unexplained ulceration in oral cavity >3 weeks or

Persistent and unexplained lump in neck

Question 21

2-week cancer pathway - Thyroid Cancer?

Answer 21

Unexplained thyroid lump

Question 22

2-week cancer pathway - Lung Cancer?

Answer 22

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

Question 23

2-week cancer pathway - Bone sarcoma?

Answer 23

XR suggests bone sarcoma

Child - within 48 hours

Question 24

2-week cancer pathway - Soft tissue sarcoma?

Answer 24

US if unexplained lump increasing in size

Child - within 48 hours

Question 25

2-week cancer pathway - Malignant Melanoma?

Answer 25

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

Question 26

2-week cancer pathway - BCC/SCC of skin?

Answer 26

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)

Question 27

2-week cancer pathway - Prostate Cancer?

Answer 27

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

Question 28

2-week cancer pathway - Bladder Cancer?

Answer 28

> 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

Question 29

2-week cancer pathway - Renal Cancer?

Answer 29

> 45 with:

Unexplained visible haematuria without UTI

Visible haematuria persisting or recurring after treatment of UTI

Question 30

2-week cancer pathway - Testicular Cancer?

Answer 30

Appointment - non-painful enlargement or change in shape or texture of testis

US - unexplained or persistent testicular symptoms

Question 31

2-week cancer pathway - Penile Cancer?

Answer 31

Penile mass or ulcerated lesion, where STI excluded

Persistent penile lesion after STI treated

Question 32

2-week cancer pathway - Child neuroblastoma?

Answer 32

Appointment within 48 hours with palpable abdominal mass or unexplained enlarged abdominal organ

Question 33

2-week cancer pathway - Child retinoblastoma?

Answer 33

2-week referral in child with absent red reflex

Question 34

2-week cancer pathway - child Wilm’s Tumour?

Answer 34

Appointment within 48 hours if:

Palpable abdominal mass

Unexplained enlarged abdominal organ

Unexplained visible haematuria