Excerpt

The guideline is divided into sections which cover in detail specific topics relating to twelve groups of cancers: lung, upper gastrointestinal cancers, lower gastrointestinal cancers, breast cancer, gynaecological cancers, urological cancers, haematological cancers, skin cancers, head and neck including oral cancers, brain/central nervous system cancers, bone and sarcoma, and children’s and young people’s cancers.

In each section, the symptoms, signs and risk factors relevant to initial assessment in primary health care are considered. The role of investigations in primary care is then addressed, and the sections conclude with consideration of factors related to delay and difficulties in diagnosis.

Two additional sections are included at the beginning of the guideline. The first deals with the needs of patients with suspected cancer at the time of referral. The second considers the process followed by healthcare professionals in reaching an initial diagnosis, and interventions to help healthcare professionals improve their ability to identify patients who should be suspected of having cancer.

Important general methodological issues are flagged up as appropriate. Where appropriate, full details of the papers reviewed are presented in the evidence tables

Contents

• Preface
• Acknowledgements
• Guideline Development Group (GDG)
• Glossary of Terms
• Part One
  • 1. Introduction
    • 1.1 Guideline aims
    • 1.2 Referral of patients with suspected cancer
    • 1.3 Principles underlying the guideline development
    • 1.4 Who should use this guideline
    • 1.5 Structure of guideline documentation
    • 1.6 Guideline limitations
    • 1.7 Scope
  • 2. Methods
    • 2.1 Introduction
    • 2.1 The developers
    • 2.3 The Guideline Development Group
    • 2.4 Developing key clinical questions (KCQs)
    • 2.5 Identifying the evidence
    • 2.6 Health economics
    • 2.7 Review of clinical audits
    • 2.8 Reviewing and grading the evidence
    • 2.9 Developing recommendations
    • 2.10 External review
  • 3. Key Priorities for implementation
    • Making a Diagnosis
    • Investigations
    • The need for support and information
    • Continuing education for health professionals
  • 4. Executive Summary
    • 4.1 Support and Information needs of people with suspected cancer at the time of referral
    • 4.2 The Diagnostic Process
    • 4.3 Lung Cancer
    • 4.4 Upper Gastrointestinal Cancer
    • 4.5 Lower Gastrointestinal Cancer
    • 4.6 Breast Cancer
    • 4.7 Gynaecological Cancer
    • 4.8 Urological Cancers
    • 4.9 Haematological Cancers
    • 4.10 Skin Cancer
    • 4.11 Head and Neck Cancer
    • 4.12 Brain and CNS Cancer
    • 4.13 Bone Cancer and Sarcoma
    • 4.14 Children’s Cancer
  • 5. Algorithms
  • 6. Audit Criteria
    • 6.1 Audit criteria
  • 7. Support and Information needs of people with suspected cancer at the time of referral
    • 7.1 Evidence Statements
    • 7.2 Introduction
  • 8. The Diagnostic Process
    • 8.1 Introduction
    • 8.2 An Example: Tiredness/fatigue
    • 8.3 Interventions to improve the ability of primary healthcare professionals to suspect cancer
  • 9. Lung cancer
    • General recommendations
    • Specific recommendations
    • Risk Factors
    • Investigations
    • Introduction
    • 9.1 Symptoms and Signs
    • 9.2 Investigations
    • 9.3 Delay and diagnostic difficulties
  • 10. Upper gastrointestinal cancer
    • General recomendations
    • Specific recomendations
    • Investigations
    • Investigations
    • Introduction
    • 10.1 Symptoms and Signs
    • 10.2 Investigations
    • 10.3 Delay and Diagnostic Difficulties
  • 11. Lower gastrointestinal cancer
    • General recommendations
    • Specific Recomendations
    • Risk Factors
    • Investigations
    • Introduction
    • Audits of cancer referrals
    • 11.1 Symptoms and Signs
    • 11.2 Investigations
    • 11.3 Delay and Diagnostic Difficulties
  • 12. Breast cancer
    • General recommendations
    • Specific Recomendations
    • Investigations
    • Introduction
    • 12.1 Signs and Symptoms
    • 12.2 Investigations
    • 12.3 Delay and Diagnostic Difficulties
    • 12.4 Support and Information needs
• Part Two
  • 13. Gynaecological cancer
    • General recommendations
    • Specific recommendations
    • Vulval cancer
    • Introduction
    • Review of referral audits
    • 13.1 Symptoms and Signs
    • 13.2 Investigations
    • 13.3 Delay and Diagnostic Difficulties
  • 14. Urological cancers
    • General recommendations
    • Specific recommendations
    • Introduction
    • Review of cancer referral audits
    • 14.1 Symptoms and Signs
    • 14.2 Investigations
    • 14.3 Delay and Diagnostic Difficulties
  • 15. Haematological cancers
    • General recommendations
    • Specific Recommendations
    • Investigations
    • Introduction
    • Review of cancer referral audits
    • 15.1 Signs and Symptoms
    • 15.2 Investigations
    • 15.3 Delay and Diagnostic Difficulties
    • 15.4 Support and Information needs
  • 16. Skin cancer
    • General recomendations
    • Specific recommendations
    • Investigations
    • Introduction
    • 16.1 Symptoms and Signs
    • 16.1 Investigations
    • 16.3 Delay and Diagnostic Difficulties
  • 17. Head and Neck cancer
    • General recommendations
    • Specific recommendations
    • Investigations
    • Introduction
    • 17.1 Signs and symptoms
    • 17.2 Investigations
    • 17.3 Delay and Diagnostic Difficulties
    • 17.4 Support and Information needs
  • 18. Brain and CNS cancer
    • General recommendations
    • Specific Recomendations
    • Headaches
    • Seizures
    • Other neurological features
    • Risk Factors
    • General recommendations
    • Introduction
    • 18.1 Signs and Symptoms
    • 18.2 Investigations
    • 18.3 Delay and Diagnostic Difficulties
    • 18.4 Support and Information needs
  • 19. Bone cancer and sarcoma
    • General recommendations
    • Specific Recommendations
    • Introduction
    • Review of cancer referral audits
    • 19.1 Symptoms and Signs
    • 19.2 Investigations
    • 19.3 Delay and Diagnostic Difficulties
  • 20. Children’s and Young People’s Cancer
    • General Recommendations
    • Specific Recommendations
    • Investigations
    • Introduction
    • 20.4 Signs and Symptoms
    • 20.2 Investigations
    • 20.3 Delay and Diagnostic difficulties
    • 20.4 Support and Information needs
  • 21. Research recommendations
    • 21.1 Introduction
• Reference List
• Appendices
  • Appendix A Evidence Tables
  • Appendix B Evidence Tables
  • Appendix C The Health Economics of Referral for Suspected Colorectal Cancer
  • Appendix D An example search strategy