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Non-Specific Symptoms Pathway

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