1. How to manage suspected cancer
Sarah Slater

2. Model of Care
Setting out 104 recommendations across 13 care pathways, the Model of Care’s key recommendations were to:
Help diagnose cancer earlier : Late diagnosis of cancers with many cancers diagnosed at a late stage when successful treatment is less likely;
Improve patient care and reduce inequalities in access to and uptake of services
Improve patient outcomes
Improve patient experience.

3. Hence development of fast track referrals
Pathways for Upper GI/ Urology/ Haem Oncology/ Bone and Sarcoma/ Brain/ Ovary/ Lung/Skin/Breast
Some patients don’t fit into these pathways.

4. What to do for suspected cancer
My role=Lead for CUP
Peer review measure for Acute Oncology
Fast track pts with suspicious imaging: lung nodules; bone lesions.
Lead on appropiate next steps

5. MUO 15% cancer diagnoses present as metastases
In 2/3, will find the primary.
For the rest (5%)=provisional CUP
Most common sites- pancreas and lung, then colon,stomach,oesophagus,ovary,prostate,breast

6. Clinical management of patients presenting with CUPs.
Fizazi K et al. Ann Oncol 2011;22:vi64-vi68
© The Author Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please

7. Recommendation
• Offer the following investigations to patients with MUO, as clinically appropriate, guided by the patient’s symptoms:
− comprehensive history and physical examination including breast, nodal areas, skin, genital, rectal and pelvic examination
− full blood count; urea, electrolytes and creatinine; liver function tests; calcium; urinalysis; lactate dehydrogenase

8. Section 3 CLINICAL INFORMATION
THERE MUST BE IMAGING SUGGESTIVE OF METASTATIC DISEASE BEFORE ANY REFERRAL USING THIS FORM, AND PLEASE SEND REPORT.
*If patient has a history of cancer please consider whether this is more likely to be a recurrence than a true unknown primary cancer. Patients with suspected recurrence should be referred back to the site specific team.
[ ] USS: Specify site
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[ ] CT scan: Specify site
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[ ] MRI: Specify site
Symptoms accompanying suspected cancer imaging eg
[ ] Progressive unintentional weight loss
[ ] anorexia
[ ] Pain: Specify site
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[ ] other:
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Examination findings and blood tests if the latter performed.
Specify site: