Pathway for patients with suspected HPB Cancer Inter Provider Transfer Maximum Wait (Days) Pathway for patients with suspected HPB Cancer Provide information and psychological support throughout the patient journey Referral received in secondary care 10 Days Clinical history Physical examination Abdominal ultrasound Imaging of the chest First Seen Rapid specialist assessment & one stop diagnostic service 10 Holistic assessment and AHP rehabilitation consideration CT ERCP +/- biopsy Further diagnostic investigations as indicated Allocate HPB CNS 16-18 years old – refer to Paediatric Oncology (GNCC) for treatment and TYA MDT for discussion 19-24 years old – continue on tumour site specific pathway & refer to TYA MDT for discussion. Is HPB cancer still suspected? No Manage as appropriate and remove from cancer pathway Inform patient's GP of serious diagnosis See TYA pathway Yes Is patient to be managed locally, has tissue diagnosis been confirmed See HPB Rehabilitation Care Pathway liaise & involve healthcare professionals as required No Yes 15 Days Inter Provider Transfer Network Best Practice Specialist MDT to discuss treatment & rehabilitation plan Link with specialist MDT Consideration for clinical trial Local MDT discussion 25 6 Days CT MRI PET Scan EUS +/- biopsy Laparoscopy +/- biopsy ERCP +/- biopsy Staging Investigations as indicated Agree proposed treatment plan with patient Agree proposed treatment plan with patient Decision to treat 31 21 Days Surgical resection Best Supportive Care Radiotherapy Chemotherapy First Treatment 62 Specialist MDT to review treatment and rehabilitation plan plus consideration for clinical trials Is further treatment Required? Earliest Clinical Appropriate Date for commencement of subsequent treatment Yes ECAD date No Appropriate after care HPB Cancer Pathway