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By Dr Varuna Paranahewa

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

2 Lung cancer (NICE CG121) 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

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

4 Lung Cancer Pathway

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

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

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

8 Symptoms and signs indicating urgent chest X-ray
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.

9 Signs and symptoms indicating urgent and immediate referral
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

10 Offer Urgent 2 Week referral to Chest physician if:
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

11 Groups that are not covered by NICE
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)

12 Thank You

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