Cancer presentation by system and referral Flashcards
What are some general red flags for cancer?
Weight loss
Loss of appetite
Night sweats
Fatigue
What are some paraneoplastic effects of cancer?
PUT AT THE END
When do you refer people for lung cancer?
Urgent appointment (<2wks) if:
- CXR findings suggesting lung cancer
- Aged >40yrs with unexplained haemoptysis
When do you offer an urgent CXR to assess for lung cancer?
Urgent = <2wks
People aged >40yrs if:
2+ of following unexplained symptoms or if they have ever smoked and have 1+ following unexplained symptoms
- Cough
- Fatigue
- Shortness of breath
- Chest pain
- Weight loss
- Appetite loss
Consider if:
- Persistent/recurrent chest infections
- Finger clubbing
- Supraclavicular lymphadenoapathy or persistent cervical lymphadenopathy
- Chest signs consistent with lung cancer
- Thrombocytosis
When should you consider urgent CXR to check for mesothelioma?
Aged >40 if: 2x following OR 1x following and have smoked OR 1x following and exposed to asbestos: - Cough - Fatigue - SOB - Chest pain - Weight loss - Appetite loss
Consider if:
- Finger clubbing
- Chest signs compatible with pleural disease
Urgent referral to suspected cancer pathway if CXR findings +ve
When should you refer someone using an urgent suspected cancer referral for colorectal cancer?
Age >40yrs with unexplained weight loss and abdo pain
OR
Aged >50yrs with unexplained rectal bleeding
OR
Aged >60yrs with iron deficiency anaemia OR change in bowel habit
OR
Tests show occult blood in faeces
What happens if you are suspicious of colorectal cancer but the person does not fulfil the urgent referral criteria?
If unexplained symptoms without rectal bleeding - test for occult blood in faeces:
- OC Sensor, HM‑JACKarc and FOB Gold quantitative faecal immunochemical tests
When should you refer someone using an urgent suspected cancer referral for breast cancer?
Aged >30 with an unexplained breast lump +/- pain OR
Aged >50 with any of the following symptoms in one nipple only:
- Discharge
- Retraction
- Other changes of concern
Consider urgent referral if:
- Skin changes that suggest breast cancer
- > 30yrs with unexplained lump in the axilla
When should you refer someone using an urgent suspected cancer referral for prostate cancer?
If their prostate feels malignant on digital rectal examination
If PSA levels are above the age specific reference range
When should you consider a PSA and DRE for prostate cancer?
Any LUTS e.g. nocturia, urinary frequency, hesitancy, retention
OR
Erectile dysfunction
OR visible haematuria
How should you manage a patient with suspected stomach cancer?
Consider urgent referral if:
- Upper GI mass consistent with stomach cancer
Offer urgent upper GI endoscopy if:
- Dysphagia
- > 55yrs with weight loss and ANY of: upper GI pain, reflux, dyspepsia
How do you manage a patient with suspected liver cancer?
Urgent USS liver in people with upper abdominal mass consistent with an enlarged liver
How should you manage a patient with suspected oesophageal cancer?
Urgent upper GI endoscopy if
- Dysphagia
OR
- Aged >55 wit ANY of the following: upper abdominal pain, reflux, dyspepsia
When should you refer someone using an urgent suspected cancer referral for cervical cancer?
If, on examination, the appearance of their cervix is consistent with cervical cancer
When should you refer someone using an urgent suspected cancer referral for thyroid cancer?
If patient has an unexplained thyroid lump
When should you refer someone using an urgent suspected cancer referral for bladder cancer?
Age >45 with
- Unexplained visible haematuria without UTI
OR
- Visible haematuria that persists after resolution of UTI
(these criteria are the same for renal cancer)
OR
Aged >60 with unexplained non-visible haematuria AND
Dysuria OR raised WCC
When should you refer someone using an urgent suspected cancer referral for lymphoma?
Patients presenting with unexplained lymphadenopathy or splenomegaly
When referring, take into account associated symptoms especially fever, night sweats, shortness of breath, pruritis, weight loss
When should you refer someone using an urgent suspected cancer referral for pancreatic cancer?
Aged >40 with jaundice
Consider urgent CT/USS if aged >40 with weight loss and ANY of the following:
- Diarrhoea
- Back pain
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- New onset diabetes
How do you manage suspected leukaemia?
Very urgent (<48hrs) FBC to assess for leukaemia if any of the following:
- Pallor
- Persistent fatigue
- Unexplained fever
- Unexplained persistent or recurrent infection
- Generalised lymhpadenopathy
- Unexplained bruising
- Unexplained bleeding
- Unexplained petechiae
- Hepatosplenomegaly
When should you refer someone using an urgent suspected cancer referral for oral cancer?
unexplained ulceration in the oral cavity lasting for more than 3 weeks
OR
A persistent and unexplained lump in the neck
When should you refer someone using an urgent suspected cancer referral for malignant melanoma of the skin?
If they have a score of 3 or more on the 7-point weighted checklist:
Major features: (2 points)
- Change in size
- irregualr shape
- Irregular colour
Minor features: (1 point)
- Largest diameter 7+mm
- Inflammation
- Oozing
- Change in sensation
How do you manage suspected myeloma?
Aged >60 with hypercalcaemia OR leukopenia
AND
A presentation consistent with possible myeloma:
- Very urgent (<48hrs) protein electrophoresis and a Bence-Joens protein urine test
Aged >60 with persistent bone pain (esp back pain) or unexplained fracture:
- FBC
- Calcium profile
- Plasma viscosity/ESR
