Suspected Cancer Flashcards
Lung ca
2ww referral
CXR finding or
>40 and haemoptysis
Lung cancer
CXR
Over 40 and 2 or more: Ever smoked Asbestos exposure Cough, SOB, CP Weight loss, appetite loss, Fatigue Finger clubbing, lymphadenopathy Thrombocytosis
Upper GI cancer
2ww referral
Dysphagia or
Over 55, weight loss and…
Upper abdo pain
Reflux
Dyspepsia
Upper GI cancer
Non urgent endoscopy
Haematemesis or
Over 55 with Resistant dyspepsia Upper abdo pain and low Hb High Plt and GI disturbance N/V and GI disturbance
Pancreatic ca
2ww referral
> 40 and jaundice
Pancreatic Ca
Urgent CT scan or USS
Over 60, weight loss and.. Diarrhoea, constipation Back/Abdo pain N/V New onset DM
Chance of pancreatic Ca
Ix
CT scan or USS
BG ?new DM
Chance of upper GI Ca
Ix
Non urgent endoscopy
Bloods (Plt, Hb)
Chance lung cancer
Ix
CXR
Bloods (Plt)
Gall bladder Ca
USS under 2ww
Never just refer
Upper abdo mass
? Enlarged GB
Liver Ca
USS under 2ww
Never straight for referral
Upper abdo mass
? Enlarged liver
Chance liver cancer
Ix
USS
Bloods: LFT
Chance gall bladder Ca
Ix
USS
Bloods: LFT
Stomach Ca
2ww referral
Upper abdo mass
?stomach Ca
Endoscopy finding
Stomach Ca
2ww endoscopy
Dysphagia or
> 55 + weight loss +…
Stomach Sx
e.g. Reflux, pain
Stomach Ca
Non urgent endoscopy
Haematemesis or
>55 with Resistant dyspepsia Upper abdo pain + low hb High plt and stomach sx N/V and stomach sx
Stomach sx
N/V Haematemesis Weight loss Reflux Dyspepsia Upper abdo pain
Colorectal Ca
2ww referral
> 40 + weight loss + abdo pain or
> 50 + rectal bleeding or
> 60 + fe def anaemia or,
Change in bowel or
Occult blood in faeces
Offer faecal occult blood test
> 50 +
weight loss/abdo pain or
> 60 +
Anaemia or change in bowel
Anal Ca
2ww referral
Anal mass or ulceration.
Chance of colorectal cancer
Ix
Faecal occult blood test
Breast Ca
2ww referral
> 30 + breast lump
> 50 +
One sided nipple changes
Breast Ca
Consider 2ww referral
Skin changes ? Breast Ca
>30 and axilla lump
Breast Ca
Non urgent referral
<30 + breast lump
Ovarian Ca
2ww referral
Ascites or
Abdominal mass or
USS findings
Chance ovarian Ca
Measure CA125 + USS
Over 12x per month Persistent bloating Early satiety, loss appetite Pelvic/ abdo pain Urinary urgency/ frequency Change in vowels >50 and Sx IBS Weight loss, fatigue
Chance ovarian Ca
Ix
Ca125
USS
Endometrial Ca
2ww referral
Post menopausal bleed
>12m since menopause
Chance endometrial Ca
USS 2ww
>55 + vaginal discharge w' 1st presentation or Thrombycytosis or Haematuria or Visible haematuria and - low hb, high plt, high BG
Chance of endometrial Ca
Ix
USS
Cervical Ca
2ww referral
Vaginal examination suggestive cervical Ca
Vulval Ca
2ww referral
Lump, ulcer or bleeding
Vaginal Ca
2ww referral
Palpable mass in or at entrance to vagina
Prostate Ca
2ww referral
DRE ?prostate Ca or
High PSA
Prostate Ca
Indication DRE and PSA
Any LUTS
- (noct, freq, hesitancy, urgency, retention…)
Erectile dysfunction
Visible haematuria
Chance of prostate Ca
Ix
DRE and PSA
Bladder Ca
2ww referral
> 45 +
Visible haematuria w/o UTI
> 60 +
Non visible haematuria with
– dysuria and high WCC
Consider for Recurrent UTI
Renal Ca
2ww referral
> 45 + Visible haematuria w/o UTI
Testicular Ca
2ww referral
Non painful enlargement, change in shape or texture
Chance testicular Ca
Ix
USS
Testicular Ca
USS indication
Unexplained, persistent testicular symptoms
Penile Ca
2ww referral
Penile mass/ ulceration w/o STI
Or after STI treatment
Skin SCC
2ww referral
Exam ?SCC
Skin BCC
Routine vs 2ww referral
2ww only if
Large size of difficult site
Skin: malignant melanoma
2ww referral
Pigmented lesion + score >3/7
Or nonpigmented nodular melanoma
Score 2: Change size, irregular shape, irregular colour
Score 1: diameter>7mm, inflammation, oozing, change sensation
Melanoma scoring system
> 3 worrying
Score 2: Change size, irregular shape, irregular colour
Score 1: diameter>7mm, inflammation, oozing, change sensation
Laryngeal Ca
2ww referral
Unexplained hoarseness
Unexplained lump in neck
Oral Ca
2ww referral ?dentist
Unexplained ulceration >3w
Lump in neck, lip, oral cavity
Red or red white patch - oral cavity
Thyroid Ca
2ww referral
Unexplained thyroid mass
Moves up on swallow
CNS Ca (adults) MRI or CT 2ww indication
Progressive, sub acute loss CNS function
CNS Ca (children) 48h referral
Abnormal CNS function
Leukaemia adults
FBC indications
W/I 48h
Pallor, fatigue Fever, persistent infection Lymphadenopathy Bruising, Bleeding, Petechiae Hepatosplenomegaly
Leukaemia (children)
FBC indication
W/I 48h
Pallor, fatigue Fever, persistent infection Lymphadenopathy Bruising, Bleeding Persistent bone pain
Leukaemia (children)
Immediate referral
Petechiae
Hepatosplenonomegaly
