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Suspected Upper GI cancer 2WW pathway: direct access pilot

Suspected Upper GI cancer 2WW pathway: direct access pilot. Dr Nina Lewis Consultant Gastroenterologist and Honorary Assistant Professor. What I think. Dysphagia needs oesophageal cancer and lung cancer excluding. In appropriate patients, dysphagia lends

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Suspected Upper GI cancer 2WW pathway: direct access pilot

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  1. Suspected Upper GI cancer 2WW pathway: direct access pilot Dr Nina Lewis Consultant Gastroenterologist and Honorary Assistant Professor

  2. What I think • Dysphagia needs oesophageal cancer and lung cancer excluding. In appropriate patients, dysphagia lends itself to be investigated in a direct-to-test way

  3. What I think • Dysphagia needs oesophageal cancer and lung cancer excluding. In appropriate patients, dysphagia lends itself to be investigated in a direct-to-test way. • Patients presenting with any weight loss, iron def anaemia or diarrhoea need to be assessed in an outpatient clinic so that tests appropriate for the individual patient are organised

  4. What I think • Dysphagia needs oesophageal cancer and lung cancer excluding. In appropriate patients, dysphagia lends itself to be investigated in a direct-to-test way • Patients presenting with any weight loss, iron def anaemia or diarrhoea need to be assessed in an outpatient clinic so that tests appropriate for the individual patient are organised • Many patients do not fit into typical symptomology for a specific cancer but please continue to follow your instinct and refer

  5. Processing of Upper GI 2WW referrals Cancer Office deliver paper copies of upper GI 2WW referrals in a marked folder to Front Desk, City Hospital Endoscopy Nina Lewis or Lorraine Clark vet referrals daily by 13:00 Straight to test OGD Gastroenterology clinic

  6. Processing of Upper GI 2WW referrals Cancer Office deliver paper copies of upper GI 2WW referrals in a marked folder to Front Desk, City Hospital Endoscopy Nina Lewis or Lorraine Clark vet referrals daily by 13:00 Straight to test OGD Gastroenterology clinic • Dysphagia • Dyspepsia (that seems straightforward)

  7. Oesophageal cancer Most common presenting symptom is dysphagia

  8. Oesophageal cancer Dysphagia is caused by the malignant stricturing

  9. Lung cancer can present with dysphagia

  10. Causes of dyspepsia

  11. Chronic peptic ulcer disease Helicobacter accounts for: • 85% duodenal ulcers • 60% gastric ulcers NSAIDs account for: • 14% duodenal ulcers • 30% gastric ulcers

  12. Gastro-oesophageal reflux • Absence of oesophagitis at endoscopy does not exclude reflux (may require pH studies) • Common exposures: - young men - abdominal truncal obesity - hiatus hernia - delayed gastric emptying

  13. Functional dyspepsia

  14. Processing of Upper GI 2WW referrals Cancer Office deliver paper copies of upper GI 2WW referrals in a marked folder to Front Desk, City Hospital Endoscopy Nina Lewis or Lorraine Clark vet referrals daily by 13:00 Straight to test OGD Gastroenterology clinic • Iron def anaemia • Weight loss • Diarrhoea • Palpable mass • Anyone you are worried about

  15. Upper GI 2WW outpatient assessment for iron def anaemia • Test to confirm or refute she has bowel cancer • Test to confirm or refute she has UGI cancer • Look for other site of malignancy particularly if weight loss is present • Imaging +/- cystoscopy to confirm or refute she has urological cancer if haematuria present • Small bowel biopsy to exclude coeliac disease • Gastric biopsy to exclude helicobacter-associated gastritis whilst on aspirin

  16. Iron def anaemia and bowel cancer ~50% people with incident bowel cancer have evidence of IDA

  17. Upper GI 2WW outpatient assessment for iron def anaemia • Test to confirm or refute she has bowel cancer • Test to confirm or refute she has UGI cancer • Look for other site of malignancy particularly if weight loss is present • Imaging +/- cystoscopy to confirm or refute she has urological cancer if haematuria present • Small bowel biopsy to exclude coeliac disease • Gastric biopsy to exclude helicobacter-associated gastritis whilst on aspirin

  18. Gastric cancer • Often asymptomatic • Presence of weight loss, post-prandial vomiting, iron def anaemia all reflect advanced disease

  19. Lower GI pathway and diarrhoea

  20. Diarrhoea can be caused by many things

  21. Diarrhoea can be caused by many things

  22. Weight loss is worrying

  23. Processing of Upper GI 2WW referrals Cancer Office deliver paper copies of upper GI 2WW referrals in a marked folder to Front Desk, City Hospital Endoscopy Nina Lewis or Lorraine Clark vet referrals daily by 13:00 Straight to test OGD Gastroenterology clinic • Iron def anaemia • Weight loss • Diarrhoea • Palpable mass • Anyone you are worried about • Dysphagia • Dyspepsia (that seems straightforward)

  24. Pilot: GP direct access to Upper GI 2WW OGD or 2WW clinic GP direct access following 2WW UGI referral Straight to test OGD Gastroenterology clinic • Iron def anaemia • Weight loss • Diarrhoea • Palpable mass • Anyone you are worried about • Dysphagia • Dyspepsia (that seems straightforward)

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