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CCC > Cancer > Flashcards

Cancer Flashcards

1
Q

2 week suspected cancer referral pathway:

a) What are the red flags symptoms for lung and pleural cancers?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A 
a) RED FLAG symptoms:
=> Cough
=> Haemoptysis
=> Fatigue
=> SOB
=> Chest pain
=> Weight loss
=> Appetite loss 
=> Persistent or recurrent chest infections
=> Finger clubbing 
=> Persistent cervical lymphadenopathy over 3 weeks (urgent CXR)
=> Chest signs consistent with lung cancer
=> Thrombocytosis

b) URGENT CHEST X-RAY (within 2 weeks)
=> to assess for lung cancer in people aged > 40 years if they have 2 more of the above unexplained symptoms,
OR
=> if they have ever smoked and have 1 or more of the above unexplained symptoms

c) Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they:
• have chest X-ray findings that suggest lung cancer
• are aged 40 and over with unexplained haemoptysis
• have stridor (immediate referral)
• signs of superior vena cava obstruction (immediate referral)

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2
Q

2 week suspected cancer referral pathway:

a) What are the red flags symptoms for Mesothelioma?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A 
a) RED FLAG symptoms:
=> Cough
=> Fatigue
=> SOB
=> Chest pain
=> Weight loss
=> Appetite loss
=> Finger clubbing 
=> Chest signs compatible with pleural disease

b) URGENT CHEXT X-RAY (within 2 weeks) to assess for mesothelioma in people aged >40 years if:

  • they have 2 or more of the above unexplained symptoms OR
  • they have 1 or more of the above unexplained symptoms and have ever smoked OR
  • they have 1 or more of the above unexplained symptoms and have been exposed to asbestos

c) Refer via 2 weeks pathway if they have chest X-ray findings that suggest mesothelioma

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3
Q

2 week suspected cancer referral pathway (Upper GI tract cancers):

a) What are the red flags symptoms for Oesophageal cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

a) RED FLAGS symptoms

=> dysphagia > 3 weeks OR
=> age 55 and over with weight loss and 
- upper abdominal pain or
- reflux or 
- dyspepsia

Urgent upper GI endoscopy (within 2 weeks) referral

Consider non-urgent upper GI endoscopy in people with haematemesis

Consider non-urgent upper GI endoscopy in people aged 55 or over with:

  • treatment-resistant dyspepsia OR
  • upper abdominal pain with low haemoglobin levels (iron deficiency anaemia) OR
  • raised platelet count with any of the following:
  • nausea
  • vomiting
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain OR

• nausea or vomiting with any of the following:

  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain
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4
Q

2 week suspected cancer referral pathway (Upper GI tract cancers):

a) What are the red flags symptoms for Pancreatic cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

a) Red flag symptoms:

=> Age >60 years + weight loss + any of these symptoms 
• diarrhoea
• back pain
• abdominal pain
• nausea
• vomiting
• constipation
• new-onset diabetes
• painless jaundice (Direct referral)

b) Urgent CT scan (within 2 weeks) or urgent USS if CT unavailable to assess for pancreatic cancer in people aged 60 years and above with weight loss and any of the above symptoms.
c) Refer via 2 week pathway for pancreatic cancer if they are aged 40 and over, and have painless jaundice

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5
Q

2 week suspected cancer referral pathway (Upper GI tract cancers):

a) What are the red flags symptoms for Stomach cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A 
a) Red flag symptoms:
=> Dysphagia OR
=> aged 55 and over with weight loss and any of the following:
- Upper abdominal pain
- Reflux 
- Dyspepsia

b) Urgent upper GI endoscopy (within 2 weeks) with above findings
c) 2 week referral via cancer pathway for upper abdominal mass consistent with stomach cancer

Consider non-urgent upper GI endoscopy to assess for stomach cancer in people with

=> haematemesis OR
=> aged 55 and over with:
• treatment-resistant dyspepsia OR

  • upper abdominal pain with low haemoglobin levels (iron deficiency anaemia) OR
  • raised platelet count with any of the following:
  • nausea
  • vomiting
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain OR

• nausea or vomiting with any of the following:

  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain
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6
Q

2 week suspected cancer referral pathway (Upper GI tract cancers):

a) What are the red flags symptoms for Gallbladder / Liver cancer?
b) What are the investigations?

A

a) Mass consistent with enlarged gallbladder or enlarged liver
b) Urgent USS (within 2 weeks)

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7
Q

2 week suspected cancer referral pathway (Lower GI tract cancers):

a) What are the red flags symptoms for Colorectal cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

a) Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
• they are aged 40 and over + unexplained weight loss + abdominal pain OR

  • they are aged 50 and over + unexplained rectal bleeding OR
  • they are aged 60 and over with:
  • iron-deficiency anaemia or
  • changes in their bowel habit OR

• [FIT] tests show occult blood in their faeces

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults with a rectal or abdominal mass

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults under 50 years with rectal bleeding and any of the following unexplained symptoms:
• abdominal pain
• change in bowel habit
• weight loss
• iron-deficiency anaemia

b) Offer FIT test to assess for colorectal cancer in adults without rectal bleeding who:
• are aged 50 and over with unexplained: - abdominal pain or
- weight loss, OR

• are aged under 60 with:

  • changes in their bowel habit or
  • iron-deficiency anaemia, OR

• are aged 60 and over and have anaemia even in the absence of iron deficiency

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8
Q

2 week suspected cancer referral pathway:

a) What are the red flags symptoms for Breast cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

Refer people (male or female) using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
• aged 30 and over and have an unexplained breast lump ± pain OR
• aged 50 and over with any of the following symptoms in one nipple only:
- discharge
- retraction
• other changes of concern

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
• with skin changes that suggest breast cancer or
• aged 30 and over with an unexplained lump in the axilla.

Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain

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9
Q

2 week suspected cancer referral pathway (Gynaecological cancers):

a) What are the red flags symptoms for Ovarian cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

For women aged 18 and over:

  1. Urgent referral to a gynaecological cancer service if physical examination shows ascites and/or a pelvic / abdominal mass (which is not obviously uterine fibroids).
  2. Investigate in primary care if a woman (especially aged 50 or over) is having any of the following symptoms on a persistent or frequent basis (>12 times per month):
  • persistent abdominal distension (referred as ‘bloating’)
  • feeling full (early satiety) and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • Unexplained weight loss
  • Fatigue
  • Changes in bowel habit / symptoms of IBS (IBS rarely presents for the first time in women of this age)
  1. Primary care investigations:
    => Serum CA125
    • If serum CA125 >35IU/ml => USS of abdomen and pelvis
    • If USS suggests ovarian cancer => URGENT referral to gynaecological cancer service

=> Normal CA125 or normal USS after raised CA125 - monitor closely / investigate for other causes

=> If no other clinical causes, advise her to return to her GP if her symptoms become more frequent and persistent

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10
Q

2 week suspected cancer referral pathway (Gynaecological cancers):

a) What are the red flags symptoms for Endometrial cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Refer women using a suspected cancer pathway referral (within 2 weeks) for endometrial cancer if they are:
    => aged 55 and over
    => post-menopausal bleeding (unexplained vaginal bleeding post menopause [>12 months after menstruation has stopped])

=> Consider a suspected cancer pathway referral (within 2 weeks) for endometrial cancer in women aged under 55 with post-menopausal bleeding

  1. Consider a USS to assess for endometrial cancer in women aged 55 and over with:

• unexplained symptoms of vaginal discharge who:

  • are presenting with these symptoms for the first time OR
  • have thrombocytosis OR
  • report haematuria, OR

• visible haematuria and:

  • low haemoglobin levels OR
  • thrombocytosis, OR
  • high blood glucose levels
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11
Q

2 week suspected cancer referral pathway (Gynaecological cancers):

a) What are the red flags symptoms for Cervical / vulval / vaginal cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Cervical cancer:
    Consider a suspected cancer pathway referral (within 2 weeks) for women if, on examination, the appearance of their cervix is consistent with cervical cancer
  2. Vulval cancer:
    Consider a suspected cancer pathway referral (within 2 weeks) for vulval cancer in women with an unexplained vulval lump, ulceration or bleeding.
  3. Vaginal cancer:
    Consider a suspected cancer pathway referral (within 2 weeks) for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina
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12
Q

2 week suspected cancer referral pathway (Urological cancers):

a) What are the red flags symptoms for Prostate cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Refer people using a suspected cancer pathway (within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination.
  2. Consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in people with:
    • any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
    • erectile dysfunction or
    • visible haematuria
  3. Consider referring people with possible symptoms of prostate cancer above, using a suspected cancer pathway referral (within 2 weeks) for prostate cancer if their PSA levels are above the threshold for their age. Take into account any comorbidities

Below 40 years: Use clinical judgement

40 to 49 years: More than 2.5 mcg/l

50 to 59 years: More than 3.5 mcg/l

60 to 69 years: More than 4.5 mcg/l

70 to 79 years: More than 6.5 mcg/l

Above 79: Use clinical judgement

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13
Q

2 week suspected cancer referral pathway (Urological cancers):

a) What are the red flags symptoms for Bladder cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

Refer within 2 weeks if:

i) Aged 45 and over with:
=> unexplained visible haematuria without UTI
=> visible haematuria that persists or recurs after successful treatment of UTI

OR

ii) Aged 60 and over with:
=> unexplained non-visible haematuria and either dysuria or raised WBC

*non-urgent referral in people aged 60 and over with recurrent or persistent unexplained UTI

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14
Q

2 week suspected cancer referral pathway (Urological cancers):

a) What are the red flags symptoms for Renal cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

Refer within 2 weeks if:

Aged 45 and over with:
=> unexplained visible haematuria without UTI
OR
=> visible haematuria that persists or recurs after successful treatment of UTI

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15
Q

2 week suspected cancer referral pathway (Urological cancers):

a) What are the red flags symptoms for Testicular / Penile cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Testicular cancer: Refer within 2 weeks if:
    => Non-painful enlargement or change in shape or texture of testis
    => USS with unexplained or persistent testicular symptoms
  2. Penile cancer: Refer within 2 weeks if:
    => Penile mass or ulcerated lesion (STI excluded as cause)
    => Persistent penile lesion after treatment of STI

*consider referral for penile cancer with unexplained or persistent symptoms affected the foreskin or glans

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16
Q

2 week suspected cancer referral pathway (SKIN cancers):

a) What are the red flags symptoms for malignant melanoma?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Refer within 2 weeks if score of 3 or more:

Major features (2 points):

  • Change in size
  • Irregular shape
  • Irregular colour

Minor features (1 points):

  • Largest diameter 7mm or more
  • Inflammation
  • Oozing
  • Change in sensation
  1. Refer within 2 weeks if dermas copy suggests melanoma
17
Q

2 week suspected cancer referral pathway (SKIN cancers):

a) What are the red flags symptoms for SCC and BCC?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. SCC => 2 week referral if skin lesion suspicious of SCC
  2. BCC:
    i) Routine referral if BCC suspicion (ulcer with raised rolled edge; prominent fine blood vessels around a lesion; pearly / waxy nodule on the skin
    ii) 2 week referral only if delay may lead to significant impact due to lesion side or size
18
Q

2 week suspected cancer referral pathway (Head & Neck cancers):

a) What are the red flags symptoms for Laryngeal and Thyroid cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A
  1. Laryngeal cancer - 2 week referral if:

Aged 45 and over with:
=> persistent unexplained hoarseness
OR
=> unexplained lump in the neck

  1. Thyroid cancer -2 week referral with unexplained thyroid lump
19
Q

2 week suspected cancer referral pathway (Head & Neck cancers):

a) What are the red flags symptoms for Oral cancer?
b) What are the investigations?
c) When do you refer using suspected cancer pathway?

A

2 week referral if:
=> unexplained ulceration in the oral cavity for more than 3 weeks
OR
=> persistent and unexplained lump in the neck

Urgent referral within 2 weeks if:
=> lump on the lip or in the oral cavity
OR
=> red / red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

20
Q

Patient & family support and safety netting:

  1. Discuss with patient their preference for being involved in decision making about referral including potential risks and benefits
  2. Reassure patients as appropriate. Explain that most people will not have a diagnosis of cancer being referred and discuss alternatives / diagnoses
  3. Info given to patients & families should include:
    => where the person is being referred to

=> how long they will have to wait for the appt

=> how to obtain further info about type or cancer suspected and help before specialist appt

=> what to expect from the service the patient is attending

=> what type of tests may be carried out and what will happen during diagnostic procedures

=> how long till a diagnosis is made / test results

=> whether they can take someone to the appt

=> who to contact if they don’t receive appt confirmation

=> other sources of support i.e. Macmillan - offers with emotional, physical and financial support

A
  1. Safety-netting:
    => Ensure results on investigations are reviewed and acted upon. Possible false negatives on x-rays or FIT tests
    => Warn patient of new symptoms development or worsening symptoms then to get in contact
    => Also get in contact if continues to worry and is seeking mental / emotional support
  2. Arrange follow up in an agreed frame-time

CCC (11 decks)

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