Cancer Care Tricky Bits

Question 1

OESOPHAGEAL CANCER RED FLAG

Answer 1

With dysphagia or
Aged 55 and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia (new NICE recommendation for 2015)

Question 2

GASTRIC CANCER RED FLAGS

Answer 2

Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
With dysphagia or
Aged 55 and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia (new NICE recommendation for 2015).

Question 3

BLADDER CANCER RED FLAGS

Answer 3

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. [new 2015]

Question 4

RENAL CANCER RED FLAGS

Answer 4

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for renal 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. [new 2015]

Question 5

MELANOMA SCORING FOR REFERRAL

Answer 5

Weighted 7‑point checklist (>3)

Major features of the lesions (scoring 2 points each):

change in size

irregular shape

irregular colour.

Minor features of the lesions (scoring 1 point each):

largest diameter 7 mm or more

inflammation

oozing

change in sensation.

Question 6

PROSTATE CANCER RED FLAGS

Answer 6

2-week wait triggers
- feels malignant on digital rectal examination. [new 2015]
- PSA above age specific reference range
Investigate with DRE & PSA in 
- LUTS
- Erectile dysfunction
- Visible haematuria

Question 7

OVARIAN CANCER RED FLAGS

Answer 7

Carry out tests in primary care if woman presents >12 times/month with
- persistent abdominal distension (women often refer to this as ‘bloating’)
- feeling full (early satiety) and/or loss of appetite
- pelvic or abdominal pain
- increased urinary urgency and/or frequency
IMMEDIATELY if
- weight loss
- fatigue
- change in bowel habit