GI cancer. Sharan Pobbathi Rumina Önaç

Size: px

Start display at page:

Download "GI cancer. Sharan Pobbathi Rumina Önaç"

Amanda Martin
5 years ago
Views:

1 GI cancer Sharan Pobbathi Rumina Önaç

2 Why is this relevant? One new case per year per GP York slightly below national average

3 Contents/objectives To know the 2ww criteria and where to find them To be aware of common presenting symptoms of bowel cancer and safetynetting To understand the bowel cancer screening programme To understand stomas and common problems To be aware of palliative care issues in bowel cancer

4 How is the GP involved? Identify patients at risk of cancer Bowel symptoms Past medical history Family history Lifestyle Examination Refer patients for appropriate management 2 week wait, specialist nurse, macmillan, CAB Stoma and palliative care problems Give advice QOF!

5 Lower GI - risk factors Lifestyle/diet Inflammatory bowel disease PMC cancer FH bowel cancer DM Hormones (women)

6 Lower GI - presentation Weight loss Anaemia RIF mass Advanced L PR bleeding Pain Obstruction Tenesmus Change in bowel habit LIF mass

7 Urgent Referral Criteria Bleeding without anal sx >6wks 60+ Change in bowels >6wks 60+ Bleeding + change in bowels >6wks 40+ R sided mass Rectal mass# Iron deficiency anaemia 11 for men 10 for women

9 Upper GI risk factors Lifestyle Barrett s oesophagus Coeliac disease Not inherited!

10 Upper GI - presentation Dysphagia Odynophagia Weight loss Nausea Epigastric pain Fatty food intolerance Bloating

11 Upper GI - Referral criteria Timing not such an important issue Dysphagia Upper abdo mass 55+ with dyspepsia Dyspepsia with... weight loss Iron deficiency anaemia Persistent vomiting

13 What do I tell patients? Lifestyle advice and know your bowels! Give advice about referral procedure Timing Who will contact them and when Further tests/questions PIL Most people do not have cancer Answer questions on further management Staging/further tests Surgery Chemo/radiotherapy

14 Case studies

15 Bowel cancer screening Programme to be rolled out over 3 years Who is eligible: (every 2 years) Over 70s (make own request, max every 2 years) Patients discharged back to the screening programme to a local polyp surveillance programme to the GP for treatment under a named consultant.

16 Stoma problems Change in faeces/diet Skin problems dehydration Psychological Image/relationships Phantom rectum Restricted ADLs

17 Handy stoma accessories Caps for sport Deodorants Flatus filters Special clothes

18 Palliative care of GI cancer Liver metastases NSAIDs or steroids. squashed stomach syndrome - metoclopramide. Perineal and pelvic pain - antidepressant and/or anticonvulsant medication +- pain clinic/nerve blocks. Tenesmus refer. May respond to nifedipine. Bone metastases are rare. Refer Hiccups metoclopramide, chlorpromazine, PPI, dexamethasone

19 Other palliative care issues Bowel obstruction - syringe driver containing analgesics, anti-emetics and anti-spasmodics. Fistulae refer to MDT Anorexia and altered taste advice and low dose steroids Rectal discharge and bleeding refer Leg oedema and lymphoedema refer Anaemia consider blood transfusion.?rpt transfusion Cerebral metastases - risk of epileptic fits, consider anticonvulsant medication

20 Case study Mr Underside is 56, and is concerned about his bowel movements, which are usually regular every day, but have become more frequent and looser in nature. He has heard about the about the new bowel cancer screening programme and thinks he should have the test. What else would you ask?

21 Case study continued His bowels have been loose for 2 months but he has not had any bleeding or weight loss or abdo pain. He is diabetic and started taking metformin 2 months ago. I: he doesn t know you re the doctor! C: he is worried it could be cancer E: he is expecting a FOB test from you today What would your management be?

22 Info for patients Bowel Cancer UK Beating Bowel Cancer Lynn`s Bowel Cancer Campaign Macmillan Cancer Support Cancer Help UK Marie Curie Cancer Care Cancer Research UK The Association of Coloproctology of Great Britain & Ireland National Cancer Action Team Colostomy Association Cancer/Bowel_screening

23 Info for doctors patient_information/department/colorectal.html

Endoscopy When to use it and How to get the most out of it. Dr Deepak Suri Consultant Gastroenterologist/Hepatologist. Highgate Private Hospital

Endoscopy When to use it and How to get the most out of it Dr Deepak Suri Consultant Gastroenterologist/Hepatologist Highgate Private Hospital E: drsurigastro@gmail.com Case 1 49 year old man Asymptomatic