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Lung Suspected Cancer Referral

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					                                    LUNG Suspected Cancer Referral
                                                   (2 Week Wait Referral)
                                               To support NICE guidance 2005

  Please FAX within 24 hours to Cancer Two Week Wait Office on eFax number 020 7791 9660

Section 1 PATIENT INFORMATION (Please complete in BLOCK CAPITALS)
                                                                           Date of Referral                     /           /
SURNAME
                                                                           Date of Birth                        /           /
                                                                           NHS number
FIRST NAME
                                                                           UBRN                         -               -

Miss Mrs Ms Mr            Other:_________              M[ ]F [ ]           Home Tel.

Address                                                                    Mobile/Daytime Tel.
                                                                           Transport Y             N        Interpreter Y               N

                               Post Code                                   Language
Section 2 PRACTICE INFORMATION (Please use practice stamp if available)
Referring GP                                                                                                Locum               Y       N
Practice Address                                                       Telephone

                                                                       Fax
                               Post Code
Section 3 CLINICAL INFORMATION (please TICK all applicable entries)
              Please enclose print outs of CURRENT medications and PAST MEDICAL HISTORY
Criteria for Urgent referral                           Indications for urgent chest x-ray prior to urgent referral
[ ] Smokers or ex-smokers aged > 40 years with         [ ] Haemoptysis       No. of episodes: _________
    persistent haemoptysis
                                                       Unexplained or persistent ( > 3 weeks):
[ ] Chest X-ray suggestive of lung cancer
                                                       [ ] Chest and/or shoulder pain [ ] Dyspnoea
[ ] Normal CXR where there is a high suspicion of lung
                                                       [ ] Weight loss                  [ ] Chest signs
    cancer
                                                       [ ] Hoarseness                   [ ] Finger clubbing
[ ] History of asbestos exposure and recent onset
                                                       [ ] Cervical or supraclavicular [ ] Cough
    of chest pain, shortness of breath or unexplained
                                                           lymphadenopathy
    systemic symptoms where a CXR indicates
                                                       [ ] features suggestive of metastasis from a lung cancer
    pleural effusion, pleural mass or any suspicious
                                                           (e.g. secondaries in the brain, bone, liver, skin)
    lung pathology
                                                       [ ] Underlying chronic respiratory problems with
          If Signs of SVCO or Stridor consider             unexplained changes in existing symptoms
                     immediate referral
                  N.B. A CHEST X- RAY REPORT MUST BE ATTACHED WHERE INDICATED
unless exceptional circumstances apply (please explain):
INVESTIGATIONS [ ] CHEST X-RAY PERFORMED                          Date :      /       /           Done at:___________________
Results/Comments:

Medical History and Known Allergies                             Medication



Discussed urgent suspected cancer referral with patient: Y                        N
Discussed with the patient that they may be asked to attend an appropriate investigation prior to or at their first appt:           Y   N
Comments/other reasons for suspecting cancer

Hospital use only: (Tick where appropriate)
Date Appointment Booked:                 /     /                      Date of Referral receipt:             /       /
Target Dates       2ww        /      /              Database:                            Patient confirmed:    
                   62/7       /      /

                                  A separate letter only need accompany if you feel it necessary
                                                             Approved by the North East London Cancer Network April 2006
LOCAL CONTACT DETAILS
   Cancer Two Week Wait Office, Barts and The London NHS Trust
                 Tel Telephone: 0207 767 3333
                  E-Fax number 0207 791 9660

         For queries on appropriateness of referral please contact
      Dr. Simon Lloyd-Owen, Consultant Physician on 020 8983 2325



            CRITERIA FOR URGENT SUSPECTED CANCER REFERRAL1
                    Please FAX the referral form within 24 hours

Refer a patient who presents with symptoms suggestive of lung cancer to a team
specialising in the management of lung cancer, depending on local arrangements.
   Investigations
   Referral for diagnostic chest X-ray
     Most patients with intrathoracic tumours have an abnormal x-ray.
     PLEASE ARRANGE AN X-RAY BEFORE REFERRING.
     Many patients will present late, or with signs on an x-ray taken for other reasons.

   Patients will need an urgent chest x ray if they present with any of the symptoms or
   signs of underlying cancer mentioned in this proforma and guideline, and also if they
   have any underlying chronic respiratory problems with unexplained changes in
   existing symptoms.

   If there are x-ray features of lung cancer including:
        o slowly resolving consolidation
        o pleural effusion
        o pleural mass
   Then the patient should be referred urgently

   If the x-ray is normal, but the suspicion of cancer is slight, please speak to a chest
   physician for more guidance.

   Please note that a two-week appointment will not be issued and you will be
   contacted by the Cancer Referral Office unless:
         a) the x-ray report is faxed together with this form
         b) x-ray is normal, but high suspicion of lung cancer
         c) Smokers or ex-smokers aged > 40 years with persistent haemoptysis
         d) Other circumstances apply ~ specify on proforma


Risk factors
The following patients have a high risk of developing lung cancer:
    all current or ex-smokers
    patients with chronic obstructive pulmonary disease
    people who have been exposed to asbestos
    people with a previous history of cancer (especially head and neck)

An urgent referral for a chest X-ray or to a specialist can be considered sooner
in these patients.

Secondaries may also produce:
   o pain in the ribs, back, arm (brachial neuritis in Pancoast tumour),
   o headache (with or without vomiting fits and limb weakness),
   o superior vena caval obstruction.
Liver secondaries can produce jaundice or an enlarged liver.
Incidence2
In 2000 there were 38,410 new cases of lung cancer diagnosed in the UK.
There are about 50 new cases per 100,000 population each year. Lung cancer
is the second most commonly diagnosed cancer in the UK and causes more
than a fifth of all deaths from cancer.



1 Based on Referral Guidelines for Suspected Cancer (NICE, 2005)
  Notes in grey refer to the evidence grading used in the NICE guidelines, for more information see
  www.nice.org.uk/cg027NICEguideline
2 Lung Cancer Factsheet (Cancer Research UK, Jan 2004)

				
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