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