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GI tract lower cancers - Coggle Diagram
GI tract lower cancers
Colorectal cancer
Symptoms- diarrhoea, constipation (sometimes referred to as ‘change of bowel habit’) rectal bleeding, loss of weight, and abdominal pain.Present with anaemia, particularly iron deficiency anaemia
Investigations- Colonoscopy is considered to be the gold standard diagnostic test, though some clinicians offer flexible sigmoidoscopy to selected patients with rectal bleeding. Both these methods allow biopsy.CT colonography is increasingly used for those unfit for colonoscopy, but does not include biopsy.
These diagnostic tests can be performed with the GP retaining clinical responsibility.
anal cancer-The histology is different, with almost all being squamous cell cancers.
Symptoms- anal pain,tenesmus and rectal bleeding
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Diagnosis
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in people with a rectal or abdominal mass. Aged 50 and over with any of the following unexplained symptoms- Iron deficiency anaemia, weight loss, abdominal pain, change in bowel habit
Offer qfit testing in adults without bleeding and have unexplained symptoms that do not meet the cancer pathway referral
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if: aged 40 and over with unexplained weight loss and abdominal pain. Aged 50 and over with unexplained rectal bleeding. Age 60 and over with iron deficiency anaemia or positive qfit test
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for anal cancer in people with an unexplained anal mass or unexplained anal ulceration
Referral
Immediate: an acute admission or referral occurring within a few hours, or even more quickly if necessary.
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Referral process
Discussion with a specialist should be considered if uncertainty about the interpretation of symptoms and signs, and whether a referral is needed.
Ensure that letters about non-urgent referrals are assessed by the specialist, so that the person can be seen more urgently if necessary.
Maximum waiting period for non urgent referrals, in accordance with national targets and local arrangements.
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Include all appropriate information in referral correspondence, including whether the referral is urgent or non urgent.
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Once the decision to refer has been made, make sure that the referral is made within 1 working day.
Take part in continuing education, peer review and other activities to improve and maintain clinical consulting, reasoning and diagnostic skills, in order to identify at an early stage people who may have cancer, and to communicate the possibility of cancer to the person.
Patient support
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Discuss preferences for being involved in decision-making regarding referral options and further investigations
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