Download Lung Suspected Cancer Referral

LUNG Suspected Cancer Referral
(2 Week Wait Referral)
To support NICE guidance 2005
Please FAX within 24 hours to Cancer Pathways department: 020 8928 8836
Section 1 PATIENT INFORMATION (Please complete in BLOCK CAPITALS)
Date of Referral
Date of Birth
NHS number
UBRN
SURNAME
FIRST NAME
Miss Mrs Ms Mr
Other:_________
/
/
/
/
-
-
Home Tel.
M[ ]F [ ]
Mobile/Daytime Tel.
Address
Transport Y
N
Interpreter Y
N
Language
Ethnicity
Post Code
Section 2 PRACTICE INFORMATION (Please use practice stamp if available)
Referring GP
Locum
Practice Address
Y
N
Telephone
Fax
Post Code
Section 3 CLINICAL INFORMATION (please TICK all applicable entries)
Please enclose print outs of CURRENT medications and PAST MEDICAL HISTORY
Criteria for Urgent referral
Indications for urgent chest x-ray prior to urgent referral
[ ] Smokers or ex-smokers aged > 40 years with
[ ] Haemoptysis
No. of episodes: _________
persistent haemoptysis
Unexplained or persistent ( > 3 weeks):
[ ] Chest X-ray suggestive of lung cancer
[ ] Chest and/or shoulder pain [ ] Dyspnoea
[ ] Normal CXR where there is a high suspicion of lung
[ ] Weight loss
[ ] Chest signs
cancer
[ ] Hoarseness
[ ] Finger clubbing
[ ] History of asbestos exposure and recent onset
[ ] Cervical or supraclavicular [ ] Cough
of chest pain, shortness of breath or unexplained
lymphadenopathy
systemic symptoms where a CXR indicates
[ ] features suggestive of metastasis from a lung cancer
pleural effusion, pleural mass or any suspicious
(e.g. secondaries in the brain, bone, liver, skin)
lung pathology
[ ] Underlying chronic respiratory problems with
If Signs of SVCO or Stridor consider
unexplained changes in existing symptoms
immediate referral
N.B. A CHEST X- RAY REPORT MUST BE ATTACHED WHERE INDICATED
unless exceptional circumstances apply (please explain):
INVESTIGATIONS [ ] CHEST X-RAY PERFORMED
Date :
/
/
Done at:___________________
Results/Comments:
Medical History and Known Allergies
Medication
Discussed urgent suspected cancer referral with patient: Y
N
Discussed with the patient that they may be asked to attend an appropriate investigation prior to or at their first appt:
Comments/other reasons for suspecting cancer
Hospital use only: (Tick where appropriate)
Date Appointment Booked:
Target Dates
2ww
62/7
/
/
/
/
/
/
Date of Referral receipt:
Database:

/
Patient confirmed:
/

A separate letter only need accompany if you feel it necessary
Approved by the North East London Cancer Network April 2006
Y
N
LOCAL CONTACT DETAILS
If you wish to discuss any clinical issues concerning this referral please contact:
Dr Alistair Reinhardt
Dr Mathina Roberts
Dr Phillip Raines
Dr Simon Quantrill
Dr Ali Mohammed
Prof Michael Roberts
Julia Mcveigh
Consultant (Lead Clinician)
Consultant
Consultant
Consultant
Consultant
Consultant
Clinical Nurse Specialist
0208 535 6675
0208 539 5522- Ext 016
0208 535 5469
0208 535 6642
0208 535 5469
0208 535 6782
0208 539 5522- Ext 945
If you wish to discuss any other aspect of this referral please contact the Cancer Pathways
Office on 020 8535 6856/ 020 8535 6768 x4348 x4350
CRITERIA FOR URGENT SUSPECTED CANCER REFERRAL1
Please FAX the referral form within 24 hours
Refer a patient who presents with symptoms suggestive of lung cancer to a team
specialising in the management of lung cancer, depending on local arrangements.
Investigations
Referral for diagnostic chest X-ray
 Most patients with intrathoracic tumours have an abnormal x-ray.
 PLEASE ARRANGE AN X-RAY BEFORE REFERRING.
 Many patients will present late, or with signs on an x-ray taken for other reasons.
Patients will need an urgent chest x ray if they present with any of the symptoms or
signs of underlying cancer mentioned in this proforma and guideline, and also if they
have any underlying chronic respiratory problems with unexplained changes in
existing symptoms.
If there are x-ray features of lung cancer including:
o slowly resolving consolidation
o pleural effusion
o pleural mass
Then the patient should be referred urgently
If the x-ray is normal, but the suspicion of cancer is slight, please speak to a chest
physician for more guidance.
Please note that a two-week appointment will not be issued and you will be
contacted by the Cancer Referral Office unless:
a) the x-ray report is faxed together with this form
b) x-ray is normal, but high suspicion of lung cancer
c) Smokers or ex-smokers aged > 40 years with persistent haemoptysis
d) Other circumstances apply ~ specify on proforma
Risk factors
The following patients have a high risk of developing lung cancer:
 all current or ex-smokers
 patients with chronic obstructive pulmonary disease
 people who have been exposed to asbestos
 people with a previous history of cancer (especially head and neck)
An urgent referral for a chest X-ray or to a specialist can be considered sooner
in these patients.
Secondaries may also produce:
o pain in the ribs, back, arm (brachial neuritis in Pancoast tumour),
o headache (with or without vomiting fits and limb weakness),
o superior vena caval obstruction.
Liver secondaries can produce jaundice or an enlarged liver.
Incidence2
In 2000 there were 38,410 new cases of lung cancer diagnosed in the UK.
There are about 50 new cases per 100,000 population each year. Lung cancer
is the second most commonly diagnosed cancer in the UK and causes more
than a fifth of all deaths from cancer.
1 Based on Referral Guidelines for Suspected Cancer (NICE, 2005)
Notes in grey refer to the evidence grading used in the NICE guidelines, for more information see
www.nice.org.uk/cg027NICEguideline
2 Lung Cancer Factsheet (Cancer Research UK, Jan 2004)