2WW REFERRAL - CSA EXAM CHEAT SHEET- 1 OF 5.

Hellooo Friend!!!
Hema Here!
As a doctor,
Don't we have a crucial role in the detection of cancer?

Most important tool - 'Two- week Referral' Guidelines.

We can save lives if cancers are identified at the right time.

It is the Most Important Information We Must Know.

This is one of the topics to freshen up just before your Big Day - CSA .***

Star*** marked means - Needs to give more attention...

Get NICE referral guidelines from -
http://www.nice.org.uk/nicemedia/pdf/CG027quickrefguide.pdf

We can have scenarios either  -
To negotiate the plan to be referred for 2ww clinic or
To reassure that there is no need for 2ww referral.

Make sure the Patient understands -
Be unambiguous about the nature of the referral with the patient.
Patients sometimes findout that a clinical suspicion existed only after their hospital appointment.
This is understandably distressing and often leads to anger and shock.

Safety net and follow-up

Always advise patients to contact you if they have not heard from the hospital within two weeks.
It is good practice to see the patient after the diagnosis to offer emotional and psychosocial support.
Practise as many scenarios with your Trainer and Colleagues!

Top Ten Topics are :

1. Lung
2. GI - Upper & Lower
3. Breast
4. Gynaecological
5. Urology
6. Haematological
7. Skin
8. Head & Neck
9. Brain&CNS
10. Bone.

It is important to remember Paediatric cases as it can come not only in CSA but also in our normal surgery!

We can see the Lung and GI Guidelines in this sheet 1 of 5.
Rest in the Next sheet 2 of 5.

1. Lung

A. Admit Immediately 

     SVC obstruction & Stridor.
     (Very difficult to stimulate in CSA)


B. Urgent 2ww referral

1. Persistent Hemoptysis (Ex/Smoker)  > 40 yrs ***
2. CXR suggestive of lung cancer
3. Normal CXR but high suspicious of lung cancer.
4. CP or SOB with h/o Asbestos exposure with CXR abnormality.

Theses can be stimulated easily in CSA. This highlights the importance of exploring the occupation including previous ones and be specific in ruling out asbetos exposure, smoking history etc.


C. Urgent CXR if symptoms  > 3 weeks ***.

            (MY TIP : Remember - 3 letters in CXR - So 3  weeks)

1. Hemoptysis
2. Changes in symptoms in patients with chronic lung conditions.
3. Unexplained, Persistent (> 3 weeks)
1. Cough ***
2. Dyspnoea
3. Hoarseness ***
4. Weight loss
5. Lymphadenopathy - cervical or supraclavicular
6. Finger clubbing
7. Chest signs
8. Chest Pain or shoulder pain***
9. Secondary mets in Brain, bone, Liver, skin.

HIGH RISK - Smoking/  COPD/ Asbestosis/ Previous cancers.
Have a low threshold to seek advice and refer in these patients.

    2a. Upper GI

    Refer for Urgent Endoscopy -

• Recent onset/Unexplained/ Persistent Dyspepsia  > 55 yrs.***
• Any Age with Dyspepsia and Any of the following symptoms.

1. Chronic GI Bleeding
2. Dysphagia***
3. Suspicious Ba meal result
4. Progressive unintentional Weight loss
5. Persistent Vomiting ( > 6 weeks)
6. Iron deficiency Anemia***
7. Epigastric mass

  Urgent 2WW referral for

1. Dysphagia***
2. Abdominal Mass***
3. Weight loss with
1. Abdominal Pain           ]
2. Iron def Anaemia         ]---> without DYSPEPSIA
3. Vomiting                        ]
4. Obstructive Jaundice***
5. Worsening of Dyspepsia in known Barrett's/ Oeso pathology/ Peptic ulcer Surgery, 20yrs ago.

Beware of subtle symptoms like jaundice, signs like abdominal mass.

These cases confirm the importance of examination.

So be systematic in your consultation and follow an regular order, write them up as a list and practise...

Have that LIST in between you and the stimulator...

Have a glance at it and follow to have a structured consultation...

      2b. Lower GI

2WW Referral - It has criteria depends on ages***. - Any, 40 or 60 yrs.

Any age with -

1. Abdominal/ rectal Mass.

2. Unexplained Fe def Anaemia and Hb -       
        Males <11 ***
        Females <10 *** (non menstruating)

(MY TIP - 11 is in MaLLe.  Also 10 in women)

3. Symptoms with Red flags - Ulcerative Colitis, FH of bowel cancer.


If >40 yrs - Both symptoms for > 6 weeks.
PR bleeding with change in bowel habits or increased stool frequency.

If > 60 yrs - Any one of the above symptom for  > 6 weeks.

               (My tip -  Colonic Chaos for Cix weeks)


Thats all in this post - sheet 1 of 5.

It will be tooooo much to take in ...

The Secret of Success in CSA is to Practise as many scenarios as possible... to remember the age, weeks etc...

Have FUN!

Remember the star *** marked ones!

So we will see the next Topics in next sheet 2 of 5:-)

To Your Success,

Hema xoxo.


P.S.

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