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GI CANCERS -lower cancers - Coggle Diagram
GI CANCERS -lower cancers
Diagnosis
Unexplained Appetite Loss - Lung cancer, Oesophageal, Stomach, Colorectal, pancreatic bladder or renal
assess for additional symptoms, signs or findings
Offer urgent investigation or suspected cancer pathway refer 2 weeks appt
Deep Vein Thrombosis -Urogenital, Breast, Colorectal or Lung
assess for additional symptoms, signs or findings . Consider urgent investigation or suspected cancer pathway
Weight loss Unexplained - Colorectal, Gastro-oesophageal, Lung, Prostrate, Pancreatic or Urological Cancer
assess for additional symptoms, signs or findings. Offer urgent investigation or suspected cancer pathway referral 2 week appt
Anal Mass or Anal Ulceration Unexplained - Consider suspected cancer pathway referral appt 2 weeks
Anaemia (iron deficiency) - Colorectal
Offer quantitative faecal immunochemical testing (FIT)
Anaemia ( non-iron deficiency) aged 60 years and over
Colorectal - Offer FIT
Abdominal Mass - Colorectal
Offer FIT
Age 40 years and over /unexplained weight loss/abdominal pain - Colorectal. Age 50 years /over with unexplained rectal bleeding/abdominal pain/weight loss/change in bowel habit
Offer FIT
Age under 50 with rectal bleeding/unexplained abdominal pain/ weight loss - Colorectal
Offer FIT
Occult blood in faeces - Colorectal. Rectal Mass -Colorectal
Refer adults using suspected cancer pathway referral appt 2 weeks
Recognition and Referral
Immediate Referral - acute admission/referral within few hours
Urgent - within 2 weeks
Very urgent - within 48 hours
Non - urgent - timescale generally used for referral or investigation
When to refer - Offer FIT with abdominal mass, change in bowel habit, iron -deficiency anaemia, aged 40 years with over unexplained weight loss /abdominal pain. Age under 50 years with rectal bleeding /abdominal pain, weight loss. Aged 50 years and over with rectal bleeding/abdominal pain /weight loss. Age 60 years and over/ anaemia in absence of iron deficiency.
Offer FIT even if previous Negative FIT via NHS bowel screening
Refer Adults for suspected cancer pathway 2 weeks for colorectal cancer if FIT result at least 10mcg of haemoglobin per gram faeces
Consider referral cancer pathway two weeks for suspected anal cancer with unexplained anal mass or unexplained anal ulceration
Diagnostic /Referral Process- discuss with specialist if uncertain re interpretation of symptoms/signs .
Put in place local arrangement to ensure non urgent referral are assessed by specialist, ensure maximum waiting period for non-urgent referrals within national targets.
Take part in continuing education, peer review /other activities to improve /maintain clinical consulting, reasoning/diagnostic skills
Discuss with people/carers suspected cancer /their preference/referral options /further investigations/potential risks/benefits. Give info on possible diagnosis - benign or malignant. Info on suspected cancer /how to obtain further info/ type of tests/ what happens during diagnostic procedures. Info on language ability/culture.
Safety Netting - monitoring low risk people with symptoms in primary care.
Explain to look out for symptoms and when to return for re-evaluation.
Ensure investigations are reviewed and acted upon, be aware of possibility of false-negative results for CXR and tests for occult blood in faeces.
Consider review for persons with symptom associated with increased risk of cancer but not met criteria or referral or other.
Presentation
Colorectal Cancer
Diarrhoea/Constipation/rectal bleeding/loss of weight/abdominal pain.
Anaemia - iron deficiency anaemia
Colorectal cancer with other cancers like intra-abdominal ones
Symptoms may be misdiagnosed as non-malignant like irritable bowel disease
Colonoscopy as gold standard diagnostic test /Flexible sigmoidoscopy with rectal bleeding.
CT colonography
Anal Cancer
Considered from colorectal cancer - with almost all being squamous cell cancers
Symptoms of anal pain, tenesmus and rectal bleeding
Diagnosis by direct visualization (proctoscopy/sigmoidoscopy) and biopsy
Proctoscopy can be performed by GP in primary care