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How to manage suspected cancer Sarah Slater Model of Care Setting out 104 recommendations across 13 care pathways, the Model of Care’s key recommendations were to: Help diagnose cancer earlier : Late diagnosis of cancers with many cancers diagnosed at a late stage when successful treatment is less likely; Improve patient care and reduce inequalities in access to and uptake of services Improve patient outcomes Improve patient experience. Hence development of fast track referrals Pathways for Upper GI/ Urology/ Haem Oncology/ Bone and Sarcoma/ Brain/ Ovary/ Lung/Skin/Breast Some patients don’t fit into these pathways. What to do for suspected cancer My role=Lead for CUP Peer review measure for Acute Oncology Fast track pts with suspicious imaging: lung nodules; bone lesions. Lead on appropiate next steps MUO 15% cancer diagnoses present as metastases In 2/3, will find the primary. For the rest (5%)=provisional CUP Most common sites- pancreas and lung, then colon,stomach,oesophagus,ovary,prostate ,breast Clinical management of patients presenting with CUPs. Fizazi K et al. Ann Oncol 2011;22:vi64-vi68 Recommendation • Offer the following investigations to patients with MUO, as clinically appropriate, guided by the patient’s symptoms: − comprehensive history and physical examination including breast, nodal areas, skin, genital, rectal and pelvic examination − full blood count; urea, electrolytes and creatinine; liver function tests; calcium; urinalysis; lactate dehydrogenase Section 3 CLINICAL INFORMATION THERE MUST BE IMAGING SUGGESTIVE OF METASTATIC DISEASE BEFORE ANY REFERRAL USING THIS FORM, AND PLEASE SEND REPORT. *If patient has a history of cancer please consider whether this is more likely to be a recurrence than a true unknown primary cancer. Patients with suspected recurrence should be referred back to the site specific team. [ ] USS: Specify site ___________________________ [ ] CT scan: Specify site __________________________ [ ] MRI: Specify site __________________________ Symptoms accompanying suspected cancer imaging eg [ ] Progressive unintentional weight loss [ ] anorexia [ ] Pain: Specify site _______________________ [ ] other: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ Examination findings and blood tests if the latter performed. Specify site: ________________________________ ________________________________