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Respiratory Medicine The Urgent Referral By Dr Varuna Paranahewa GP ST3.

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Presentation on theme: "Respiratory Medicine The Urgent Referral By Dr Varuna Paranahewa GP ST3."— Presentation transcript:

1 Respiratory Medicine The Urgent Referral By Dr Varuna Paranahewa GP ST3

2 ∗ 39,000 new cases of lung cancer in the UK each year ∗ 35,000 people die from the condition; more than for breast cancer and colorectal cancer combined ∗ 5.5% of lung cancers are currently cured Lung cancer (NICE CG121)

3 ∗ public better informed of the symptoms and signs that are characteristic of lung cancer ∗ Drs aware of Indications for Urgent CXR & Urgent Referral The importance of early diagnosis (1.1.1)

4 Lung Cancer Pathway

5 ∗ What would you consider… ∗ Can you get at least 10? All 11? Urgent CXR Rules

6 ∗ What would you consider… ∗ Can you get the 2 rules to admit ? ∗ Now think 3 rules for 2 week rule. Immediate Referral to Respiratory Medicine

7 Could we take on NICE ? How well did we do?

8 ∗ Offer URGENT CXR (report in 5 days) to patients presenting with haemoptysis or chronic resp disease with change in symptoms ∗ or any of the following if unexplained or persistent ( >3 weeks):  cough  chest/shoulder pain  dyspnoea  weight loss  chest signs  hoarseness  finger clubbing  signs suggesting metastases (for example, in brain, bone, liver or skin)  cervical/supraclavicular lymphadenopathy. Symptoms and signs indicating urgent chest X-ray

9 Offer urgent referral to Chest physician Or Admit if either of the following are present: ∗ signs of superior vena cava obstruction (swelling of the face and/or neck with fixed elevation of jugular venous pressure) ∗ stridor Signs and symptoms indicating urgent and immediate referral

10 ∗ Persistent haemoptysis in a smoker or ex-smoker older than 40 years … (CXR in pipeline, but no need to wait for result) ∗ a CXR or CT scan suggests lung cancer (including pleural effusion and slowly resolving consolidation) or ∗ CXR is normal but there is a high suspicion of lung cancer ∗ A history of Asbestos exposure with recent onset of chest pain/breathlessness/ unexplained systemic symptoms, where the CXR suggests pleural effusion/pathology or lung pathology Offer Urgent 2 Week referral to Chest physician if:

11 ∗ Adults with mesothelioma. ∗ Adults with lung metastases arising from primary cancers originating outside the lung. ∗ Children (younger than 18) with lung cancer. ∗ Adults with rare lung tumours (for example, pulmonary blastoma). ∗ Adults with benign lung tumours (for example, bronchial adenoma) Groups that are not covered by NICE

12 Thank You


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