Brain and CNS tumours Presentation pathway

Transcription

1 Brain and CNS tumours Presentation pathway Ref: AngCN-SSG-BC16 Page 1 of 8

2 1 Background and Scope This presentation pathway deals with the pathway of referral from all aspects of primary care to hospitals providing the diagnostic process for tumours of the brain and central nervous system. It also covers the pathway of referral when a patient presents to a hospital doctor who is not a member of a brain and CNS MDT or part of the diagnostic service. It covers the referral of newly presenting patients and patients presenting with symptoms suggestive of recurrence. 2 Primary Care referral guidelines for suspected brain and CNS cancers Patients presenting to primary care with symptoms suggestive of a brain or CNS cancer should be referred in accordance with NICE referral guidelines for suspected cancer (NICE 2005). See appendix A for the NICE referral guideline for suspected brain and CNS cancers. For access to the full guideline go to: Hospital Addenbrookes Hospital Bedford Hospital Hinchingbrooke Hospital Ipswich Hospital James Paget Hospital Contact point for urgent two week wait referrals Patients are usually referred as emergencies to the neurosurgical registrar on call via main Switchboard Refer to Bedford Hospital using a 2WW proforma (either by fax or by choose and book). Faxed referrals should be sent to Refer using the 2WW into Hinchingbrooke via Chose & Book or dedicated Fax Or refer straight to Addenbrookes Hospital. Refer to The Ipswich Hospital NHS Trust using a 2WW proforma via Choose & Book or direct fax to the 2WW Office on Refer directly to Addenbrookes Hospital Norfolk and Norwich Hospital Peterborough Hospitals Refer to NNUH using the standard hospital 2week wait proforma Refer using 2WW form available on GP extranet. On completion please attach to the UBRN or FAX to (2ww Office), or to Peh-tr.2WWreferralspbh@nhs.net QEH, Kings Lynn Refer using the 2WW route into QEH using fax or use Choose & Book. Or refer straight to Addenbrookes Hospital West Suffolk Hospital Refer patients with the suspicion of Brain and CNS malignancy directly to Addenbrookes hospital. Any other referrals to hospital using normal outpatient referral systems. Fax no: or via Choose and Book system. Page 2 of 8

3 3 Contact points for primary care and hospital doctors Full details of referral pathways are in the clinical guidelines available on the Anglia Cancer Network website at Referrals to Addenbrookes Hospital For any patient with imaging evidence of a tumour, all referrals should be made via the on call neurosurgical registrar via Addenbrookes contact centre bleep All diagnostic imaging suggestive of primary CNS tumours should be referred to the relevant neurosciences MDT within two working days (11-1C-106k). If imaging undertaken confirms a tumour diagnosis, then a referral proforma must be completed and sent to the MDT office at add-tr.cancermdt@nhs.net. The Brain / CNS Patient Pathway Coordinator (PPC) needs to be informed of such a referral in order to track the patient and to send a tertiary referral form to Addenbrookes Hospital. Please contact the Brain / CNS PPC via cancerppc@jpaget.nhs.uk or via Norfolk and Norwich Hospital Refer to neurology department or directly to Addenbrookes if diagnosed (as above). 3.1 Cerebral metastases For suspected cerebral metastases arising from a known primary refer back to the site specialist consultant where previous history will be taken into account when making a treatment decision. For suspected cerebral metastases where the primary is unknown: If you re a GP please refer as per section 2 of this document If you re a neurologist please investigate further to determine the primary, or refer to Addenbrookes for biopsy as per section 3 of this document, as per the Anglia Cancer Network Neuro-oncology Guidelines. 3.2 Pituitary tumours Refer to the endocrinology team at the patients local hospital, as follows. Addenbrookes Hospital Via: Box: 281 Or New appointments: Professor VKK Chatterjee Dr M Gurnell Dr D Savage Dr R Sempell Dr H Simpson Dr D Wood Bedford Hospital Refer to Bedford Hospital using a 2WW proforma (either by fax or by choose and book). Faxed referrals should be sent to Page 3 of 8

4 Hinchingbrooke Hospital Refer using the 2WW into Hinchingbrooke via Chose & Book or dedicated Fax Cancer Appointments Booking Clerk Ipswich Hospital Dr Damian Morris Dr Duncan Fowler Dr Craig Parkinson Dr Gerry Rayman Kelly Pendle James Paget Hospital Dr. J. Randall, Consultant Physician Norfolk and Norwich Hospital Dr Frankie Swords Endocrinology clinic Peterborough Hospitals Dr J Roland Dr S Oyibo Both available at: Peterborough City Hospital Edith Cavell Campus Bretton Gate Peterborough PE3 9GZ (01733) QEH, Kings Lynn Dr Adrian Jennings, Consultant Physician with an interest in Endocrinology West Suffolk Hospital Routine patients should be referred to hospital outpatients booking fax number: or through Choose and Book system. Patients with an incidental diagnosis from the routine diagnostic routes are referred to the specialists of the local endocrinal team using Ca codes for onward management including referral to SMDT and Brain and CNS centre at Addenbrookes. 3.3 Spinal cord Refer to the neurosciences MDT at Addenbrookes Hospital as per section 3 of this document or to the spinal orthopaedic surgeons at Addenbrookes Hospital as follows: Spinal team Use the back pain pro forma for urgent referrals Page 4 of 8

5 3.4 Skull base tumours For suspected skull base tumours refer to the Anglia Cancer Network Primary Care Referral Guidelines for Head and Neck Cancer available at Contact points for primary care to refer back patients with symptoms suspicious of recurrence If recurrence of primary malignant brain tumour then referral is made via managing consultant oncologist. If benign recurrence then via the consultant neurosurgeon that has been managing them. Urgent problems only should be referred to the neurosurgical registrar on call via bleep Page 5 of 8

6 4 Referral guidelines for suspected brain and CNS cancer (National Institute for Clinical Excellence (NICE) 2005) For the full guideline go to Page 6 of 8

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8 5 Evidence of Agreement These Clinical Guidelines have been agreed by: The Chair of the Brain CNS NSSG Name: Sarah Jefferies Organisation: Addenbrookes Hospital Date agreed: 28 November 2011 Document management Document history Review period: Authors: 2 years Mary Emurla Sarah Jefferies Version number as approved and published: 1 Date placed on electronic library: Document Owner: Unique identifier no.: Nov 2011 Anglia Cancer Network Tel: AngCN-SSG-BC16 Monitoring the effectiveness of the Process a) Process for Monitoring compliance and Effectiveness - Review of compliance as determined by audit. Any non compliance to be presented by PQ Manager to the AngCN Business Meeting on an annual basis the minutes of this meeting are retained for a minimum of five years. b) Standards/Key Performance Indicators This process forms part of a quality system working to, but not accredited to, International Standard BS EN ISO 9001:2008. The effectiveness of the process will be monitored in accordance with the methods given in the quality manual, AngCN-QM. Equality and Diversity Statement This document complies with the Suffolk PCT Equality and Diversity statement an EIA assessment is available on request to Anglia Cancer Network PQ Manager, Gibson Centre, Exning Road, Newmarket, CB8 7JG. Disclaimer It is your responsibility to check against the electronic library that this printed out copy is the most recent issue of this document. Please notify any changes required to the Anglia Cancer Network PQ Manager Page 8 of 8