A Non-Specific Faster Diagnosis Pathway provides a fast route to cancer diagnosis and timely diagnosis of non-cancer conditions, for patients presenting with non-specific symptoms.
- Mithun Murthy; Consultant
- Jennifer Williams; Non-Specific Symptoms Project Lead
Steering Group Members
- Rhian Thomas; Cheshire and Merseyside Cancer Alliance GP lead for Halton
- Suma Kuna; Cheshire and Merseyside Cancer Alliance GP lead for Warrington
A referral letter must be attached. Once the referral has been assessed and triaged the booking team will contact the patient to offer them an appointment.
- All filter function blood tests need to be completed and reported before the point of referral
- New unexplained or unintentional weight loss (either documented > 5% in 3 months or with strong clinical suspicion)
- New unexplained constitutional symptoms of four weeks or more*. Symptoms include:
- Nausea
- Bloating
- Loss of appetite
- Sweats
- Fatigue
- Malaise
- GP gut feeling of cancer diagnosis - reasons to be clearly described at referral
- New unexplained vague abdominal pain of four weeks or more*
- New unexplained, unexpected or progressive pain, including bone pain of 4 weeks or more.
- Abnormal laboratory findings not explained by established or self-limiting disease and not needing admission (e.g. Significantly raised CRP and infection excluded, ALP >x2, raised calcium, platelets >400 men, or >450 women alongside other symptoms);
- Imaging showing suspicion of cancer and the primary site is not clear clinically or radiologically (namely Malignancy of Unknown Origin (MUO) and Cancer of Unknown Primary (CUP))
NB: * = less if significantly concerned
- Full physical examination
- Chest X-Ray (if not had within the last 3 months)
- Dipstick urine test
- FIT (where applicable)
- FBC
- ESR and/or CRP
- U&E with eGFR
- LFTS (including globulins)
- TFTS
- HBA1c
- Bone profile
- B12/Ferritin/Folate (if anaemic)
- CA-125 (Women)
- PSA (Men)
- B12/Ferritin/Folate & Iron studies (if anaemic)
Mandatory Investigations are included in a full ICE bundle named non-specific symptoms pathway
- Patient has specific alarm symptoms warranting referral onto a single site-specific pathway (in line with NG12) (shortness of breath, cough, rectal bleeding, altered bowel habit, dysphagia, abnormal vaginal bleeding, melaena, post-menopausal bleeding, haematemesis, haematuria, haemoptysis).
- Patient is too unwell or unable to attend as an outpatient or needs acute admission.
- Patient is more likely to have a non-cancer diagnosis suitable for another specialist pathway.
- Patient is currently being investigated for the same problem by another specialist team.
- Patient will be contacted by Sophie (CNS) for telephone triage assessment
- Key worker allocated from the moment of referral
- Further investigations- diagnostic bundle- if clinically indicated
- Post investigations discussion at local NSS MDT
- If cancer diagnosed, onward referral to appropriate site specific pathway
- If non-cancer other pathway indicated- onward referral
- If no cancer and no other pathology- discharged to GP
- You and your patient will be kept updated
If you have any queries about a referral or want to find out more about the service, please do not hesitate to contact us.
Call us on 01925 275231 / 01925 662896
Or
Email us on whh.nss@nhs.net