new nice guidelines suspected cancer mustafa - new nice gui… · what changed - penile consider a...
TRANSCRIPT
NEW NICE GUIDELINES
SUSPECTED CANCER: RECOGNITION AND REFERRAL
Dr A Mustafa
GP Cancer Lead
Improving the Pathway for Prostate Cancer
02/07/2015
PUBLICITY
THE CHANGE
Primary care input
Based on symptoms
PPV lowered from 5 to 3%
To involve direct access investigations as well as referral
CHALLENGES IN PRIMARY CARE
More primary care based
Each cancer is still rare.
Keep skills
Work load?
CHALLENGES WITH THE GUIDANCE
ITSELF
Full guidance is 378 pages
Quick guidance is 94 pages
View from RCR
HELP
Technology.
IT systems = update proformas.
RAT.
HELP
RAT???
HELP
Risk Assessment Tools
Q-cancer
MacMillan eCDS tool
SECTIONS TO REVIEW
Urological Cancers
Urological symptoms
WHY CHANGE?
Incidence of cancer
Outcome in UK compared to
other countries
WHAT CHANGED – CANCER SITES
Prostate
Bladder
Renal
testicular
penile
WHAT CHANGED - PROSTATE
Refer men using a suspected cancer pathway
referral (for an app within 2 weeks) for prostate
cancer if their prostate feels malignant on
DRE. [new 2015]
WHAT CHANGED - PROSTATE
Consider a PSA test & DRE to assess for
prostate cancer in men with:
LUTS
ED
Visible Haematuria
WHAT CHANGED - PROSTATE
Refer men using a suspected cancer pathway
referral (for an app within 2 weeks) for prostate
cancer if their PSA levels are above the
age-specific reference range. [new 2015]
WHAT CHANGED - BLADDER
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:
Age ≥ 45 and have:
Unexplained vsbl H without UTI
Persistent or recurring vsbl H after treatment
Age ≥ 60, have n-vsble H & either dysuria or ↑WBC. [new 2015]
WHAT CHANGED - BLADDER
Consider non-urgent referral for bladder
cancer in people aged 60 and over with
recurrent or persistent unexplained UTI. [new
2015]
WHAT CHANGED - TESTICULAR
Consider a suspected cancer pathway referral (for an app within
2 weeks) for testicular cancer in men if they have a non-painful
enlargement or change in shape or texture of the testis. [new
2015]
Consider a direct access ultrasound scan for testicular cancer in
men with unexplained or persistent testicular symptoms. [new
2015]
WHAT CHANGED - PENILE
Consider a suspected cancer pathway referral (for an
appointment within 2 weeks) for penile cancer in men if they
have either:
a penile mass or ulcerated lesion, where a STI has been excluded as a cause,
a persistent penile lesion after treatment for a sexually transmitted infection has been completed. [new 2015]
Consider a suspected cancer pathway referral (for an
appointment within 2 weeks) for penile cancer in men with unexplained or persistent symptoms affecting the foreskin or glans. [new 2015]
UROLOGICAL SYMPTOMS
Dysuria
ED
Haematuria
Testicular symptoms
LUTS
UROLOGICAL SYMPTOMS - DYSURIA
Symptom and specific
features
Possible cancer Recommendation
Dysuria with
unexplained non-visible
haematuria, 60 and
over
Bladder Refer using a suspected
cancer pathway
referral (for an app
within 2 weeks)
UROLOGICAL SYMPTOMS - ED
Symptom and specific
features
Possible cancer Recommendation
Erectile dysfunction in men
Prostate Consider a PSA and DRE.
UROLOGICAL SYMPTOMS - HAEMATURIA
Haematuria (vsbl & unexplained) either
without UTI or that persists or recurs after successful treatment of UTI, 45 and over
Bladder or renal Refer using a suspected cancer
pathway referral (for an app within 2 weeks)
Haematuria (n-vsbl and unexplained) with dysuria or raised ↑WBC on a blood test, 60
and over
Bladder Refer using a suspected cancer pathway referral (for an app
within 2 weeks)
Haematuria (visible) with ↓Hb or thrombocytosis or ↑glucose levels or
unexplained vag discharge in women 55 and over
Endometrial Consider a direct access ultrasound scan
Haematuria (vsbl) in men Prostate Consider PSA test and DRE
UROLOGICAL SYMPTOMS - TESTICULAR
Testis enlargement or
change in shape or
texture (non-painful) in
men
Testicular Consider a suspected cancer
pathway referral (for an app
within 2 weeks)
Testicular symptoms
(unexplained or
persistent), men
Testicular Consider a direct access
ultrasound scan
UROLOGICAL SYMPTOMS - OTHER
UTI (unexplained and recurrent or persistent), 60 and over
Bladder Consider non-urgent referral
LUTS, such as N, urinary F, hesitancy,
urgency or retention in men Prostate Consider a PSA and DRE
Urinary urgency and/or F (increased and persistent or frequent – particularly >12X/month) in women, especially if 50 and over
Ovarian Carry out tests in primary care Measure serum CA125 in primary care