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Extra resources for Oxford Desk Reference: Oncology
An urgent referral for endoscopy or to a specialist with expertise in upper GI cancer should be made for patients of any age with dyspepsia who present with any of the following: • Chronic GI bleeding • Dysphagia • Progressive unintentional weight loss • Persistent vomiting • Iron deficiency anaemia • Epigastric mass • Suspicious barium meal result • Jaundice In patients 55 years of age and older with unexplained and persistent recent-onset dyspepsia alone, an urgent referral for endoscopy should be made.
Uk/CG27/Guidance/pdf/English Urological cancer Warning features Warning features of urological cancers include: • Lower urinary tract symptoms • Haematuria • Suspicious lumps • Bone pain Indication for emergency referral All patients presenting with features of impending or actual spinal cord compression, a presentation common in disseminated prostate cancer, need emergency evaluation (within 24 hours). Indications for urgent referral Renal and urinary bladder cancer Patients presenting with the following features need urgent referral to rule out renal and bladder cancers: • Macroscopic haematuria with or without associated urinary infection • Microscopic haematuria in adults aged ≥50 years • Recurrent or persistent urinary infection with haematuria in adults aged ≥40 years • Clinical or radiological evidence of an abdominal mass suggesting renal or bladder cancer Prostate cancer • Patients presenting with obstructive or low urinary tract symptoms suggesting prostate cancer • Progressive rise in prostate-specific antigen (PSA) or raised PSA • Symptomatic patients with high PSA (>50) • Men with hard and irregular prostate on rectal examination • Patients with any of the following unexplained symptoms: • Haematuria • Erectile dysfunction • Lower back and bone pain • Weight loss Testicular cancer • Any patient with swelling or lump in the body of testis • Any scrotal swelling which is not diagnostic of hernia and/or when the body of the testis cannot be distinguished • Unexplained persistent lower thoracic/upper lumbar pain in a young man (arising from lymph node enlargement) Penile cancer Progressive ulceration or a mass in the glans or prepuce.
Ataxia and head tilt can be associated with posterior fossa tumours in children. Risk factors High-grade tumours may present with rapidly deteriorating symptoms but in other cases, the onset of symptoms may be more insidious. Lesions in the posterior fossa are more readily seen with MRI than CT. A referral to a neurologist urgently or electively depending on other clinical findings is appropriate. Biopsy is undertaken only by the neurosurgeon. Direct referral to an oncologist Patients who have previously been treated for cancers at other sites may present with the same symptoms if they develop meta-static disease and direct referral to the oncologist who has previously treated them may be appropriate for consideration of palliative radiotherapy.