Screening / referral guidelines Flashcards
State red flag symptoms for laryngeal cancer - which warrants an urgent referral 2WW
For patients aged > 45
Persistent, unexplained hoarseness of voice
OR
Unexplained lump in the neck
State red flag symptoms for oral cancer - which warrants an urgent referral 2WW
No age specified
Unexplained ulceration in the oral cavity lasting > 3 weeks
OR
Persistent, unexplained lump in the neck
State red flag symptoms for thyroid cancer - which warrants an urgent referral 2WW
No age specified
Any unexplained thyroid lump
State red flag symptoms for malignant melanoma - which warrants an urgent referral 2WW
No age specified
Suspicious pigmented skin lesion with score of 3 or more (on 7-point weighted checklist)
OR
Dermoscopy which suggests malignant melanoma
State red flag symptoms for squamous cell carcinoma - which warrants an urgent referral 2WW
No age specified
Any skin lesion suspicious of squamous cell carcinoma
- Raised
- Ulcerated / keratinised / crusting
- Typically head/neck, back of hand
State red flag symptoms for basal cell carcinoma - which warrants an urgent referral 2WW
No age specified
ONLY consider if skin lesion suspicious of BCC and delay may have an unfavourable outcome e.g. location or size of lesion
Features:
- Waxy / pearly in appearance
- Raised, rolled edge
- Prominent fine blood vessels around lesion
State red flag symptoms for prostate cancer - which warrants an urgent referral 2WW (and which symptoms warrant a non-urgent referral)
No age range specified
PSA levels above age-range
OR
Prostate feels malignant on DRE
**Non-urgent referral if following:
- LUTS symptoms
- Erectile dysfunction
- Visible haematuria
State red flag symptoms for bladder cancer - which warrants an urgent referral 2WW (and which symptoms warrant a non-urgent referral)
Aged 45 or over with:
Unexplained visible haematuria (not UTI)
OR
Visible haematuria persisting despite UTI treatment
Aged 60 or over with:
Unexplained non-visible haematuria with either 1) dysuria 2) raised WCC
**Non-urgent referral if recurrent / persistent UTI
State red flag symptoms for renal cancer - which warrants an urgent referral 2WW
For patients aged > 45
Unexplained visible haematuria (not UTI)
OR
Visible haematuria persisting after UTI treatment
State red flag symptoms for testicular cancer - which warrants an urgent referral 2WW
Any male with the following changes to testicles:
Non-painful enlargement
Change in shape
Change in texture
State red flag symptoms for penile cancer - which warrants an urgent referral 2WW
Any male for which they have a negative STI screen, and the following symptoms:
Penile mass
Ulcerated lesion
Unexplained / persistent symptoms of foreskin or glans penis
State red flag symptoms for lung cancer - outline when urgent investigations vs urgent referral is indicated
Urgent investigation (urgent chest x-ray)
For patients aged > 40 with any
- Persistent / recurrent chest infection
- Finger clubbing
- Supraclavicular or persistent cervical lymphadenopathy
- Thrombocytosis
- Chest signs associated with lung cancer (never smoked, need 2 but if smoked only need 1)
Signs and symptoms:
- Cough
- Fatigue
- SOB
- Chest pain
- Weight loss / appetite loss
Do urgent referral (2WW) if
- Chest x-ray findings suggestive of cancer or mesothelioma
- Aged > 40 and unexplained haemoptysis
State red flag symptoms for brain / CNS cancer and when very urgent referral and urgent direct access referral are indicated
Very urgent referral:
- Under 24 and newly central neurological changes
Urgent direct access referral (direct access to MRI brain scan in 2 weeks)
- Progressive, sub-acute central neurological changes
State red flag symptoms for oesophageal cancer - which warrants an urgent referral 2WW (for endoscopy)
FOR ENDOSCOPY
Any age:
Dysphagia
Aged > 55 with:
Weight loss AND….
- Upper abdominal pain
- Reflux
- Dyspepsia
*non urgent direct access endoscopy for…
- Over 55 with treatment resistant dyspepsia
- Upper abdominal pain and low Hb
- Raised platelet count / N&V with OG cancer symptoms
State red flag symptoms for pancreatic cancer - which warrants an urgent referral 2WW vs warrants a direct access CT scan
2WW referral:
Aged > 40 with jaundice (painless but not specified in guidelines)
Direct access CT scan:
Aged > 60 and weight loss, AND
- Diarrhoea / constipation / N&V
- Pain (abdominal or back)
- New onset diabetes
CT is more appropriate as ultrasound can miss 10% of pancreatic cancers
State red flag symptoms for gall bladder cancer - which warrants a direct access ultrasound scan
Upper abdominal mass (consistent with enlarged gall bladder)
State red flag symptoms for hepatic cancer - which warrants a direct access ultrasound scan
Upper abdominal mass (consistent with enlarged liver)
State when to make the following referrals for suspected bone sarcoma
- Very urgent direct access to x-ray
- Very urgent referral
- Urgent referral
Very urgent direct access to x-ray:
Under 25 and bone swelling or pain
Very urgent referral:
Under 25 and suspicious x-ray
Urgent referral:
Over 25 and suspicious x-ray
State when to make the following referrals for suspected soft tissue sarcoma
- Very urgent direct access to USS
- Urgent direct access to USS
- Very urgent referral
- Urgent referral
Very urgent direct access to USS:
- Under 25 with lump increasing in size
Urgent direct access to USS:
- Adults with lump increasing in size
Very urgent referral:
- Under 25 with USS findings with changes suggestive of sarcoma or uncertain
Urgent referral:
- Adults with USS findings with changes suggestive of sarcoma or uncertain
State red flag symptoms for breast cancer - which warrants an urgent referral 2WW vs non-urgent referral
Aged > 30 with an unexplained breast / axilla lump (+/- pain)
Aged > 0 with unilateral nipple changes
Any age with skin changes suggestive of breast cancer
Non-urgent referral:
Aged < 30 with an unexplained breast lump (+/- pain)
State red flag symptoms for suspected leukaemia - which warrants an very urgent investigation (specialist assessment) vs very urgent blood counts (within 48 hrs)
Very urgent investigation (specialist assessment):
Unexplained petechiae
OR
Hepatosplenomegaly
Very urgent blood counts (within 48 hrs) if any of the following:
- Generalised lymphadenopathy
- Bruising / bleeding
- Pallor
- Persistent fatigue
- Fever
- Persistent or recurrent infection
State red flag symptoms for suspected lymphoma - which warrants immediate specialist assessment vs urgent referral
Immediate specialist assessment:
Under 25 with unexplained lymphadenopathy OR splenomegaly
Urgent referral:
Adults with unexplained lymphadenopathy OR splenomegaly
State red flag symptoms for suspected myeloma- which warrants an urgent investigation (further bloods) vs very urgent protein electrophoresis and Bence-Jones protein urine test (within 48 hrs)
Urgent investigation (further bloods):
Aged > 60 and persistent pain OR unexplained fracture
Very urgent protein electrophoresis and Bence-Jones protein urine test (within 48 hrs)
Aged > 60 and hypercalcaemia / leukopenia AND suspicious clinical presentation
Any age with plasma viscosity / raised ESR
State red flag symptoms for ovarian cancer - which warrants urgent referral vs urgent investigations (Ca125 +/- USS)
Urgent referral:
- Ascites
- Abdominal mass (non-fibroid)
Urgent investigations (Ca125 +/- USS):
Aged > 50 with frequent symptoms
- Abdominal pain
- Bloating
- Urine frequency or urgency
- New IBS symptoms
- Unexplained weight loss / fatigue / changes in bowel habit (colorectal cancer more likely)
State red flag symptoms for endometrial cancer - which warrants urgent referral vs direct access USS
Urgent referral:
- Aged > 55 with postmenopausal bleeding
Direct access USS:
- Vaginal discharge with thrombocytosis OR haematuria
- Visible haematuria with thrombocytopenia / hyperglycaemia / low Hb
State red flag symptoms for cervical cancer - which warrants 2WW urgent referral
Visual changes to cervix (consistent with cervical cancer)
**NOTE previous negative smear test should not deter referral
State red flag symptoms for vulvar cancer - which warrants 2WW urgent referral
Any women with unexplained vulvar lump, ulceration or bleeding
State red flag symptoms for vaginal cancer - which warrants 2WW urgent referral
Any women with unexplained palpable vaginal lump in or at the entrance to the vagina
State red flag symptoms for colorectal cancer - which warrants 2WW urgent referral
Recent positive FIT testing
Aged > 40 with unexplained weight loss AND abdominal pain
Aged > 50 with unexplained rectal bleeding
Aged > 60 with iron deficiency anaemia OR altered bowel habit
Consider urgent referral 2WW if:
Any age with a rectal or abdominal mass
Aged <50 with rectal bleeding AND
– abdominal pain
– altered bowel habit
– weight loss
– iron deficiency anaemia
State red flag symptoms for anal cancer - which warrants 2WW urgent referral
Unexplained anal mass OR ulcercation
Briefly explain the concept of cancer screening and some advantages and disadvantages
Screening aims to find cancer or precancerous changes early, leading to improved outcomes form early intervention
Advantages:
- Improved survival rates
- If found earlier, may need less treatment or less intensive treatment
Disadvantages:
- False positive = make you think you have cancer when you don’t
- May require more invasive tests (have their own side effects)
- False negative = falsely reassure you that there isn’t a cancer but it’s been missed
- May find a cancer that would have caused the patient no issues / wouldn’t have shortened their life e.g. prostate cancer
Describe breast cancer screening as if you are explaining it to a patient
Breast cancer screening involves mammograms (low-dose x-ray of the breast)
Aims to find signs of early breast cancers that are too small to see or feel
For women aged between 50-70
Advantages:
- Doesn’t prevent breast cancer, but it does reduce the number of deaths from breast cancer each year, treatment is more likely to be effective and less treatment may be needed
Negatives:
- False positive = may require further testing
- False negative = may be falsely reassured
- Further investigations can be more invasive and own side-effects
State the aspects of health that should be covered in a cancer history
- Physical health
- Psychological health
- Spirituality
- Social factors / impact
List some of the adult UK screening programmes
- AAA
- Bowel
- Breast
- Cervical
- Diabetic Eye
