SWAG Cancer of Unknown Primary (CUP) Referral Processes The SWAG network site specific groups refer any patient with metastatic carcinoma of unknown origin on for discussion to the specialist carcinoma of unknown primary (CUP) MDTs. Important Definitions: Malignancy of undefined primary origin (MUO): this is metastatic malignancy identified after a limited number of tests, without an obvious primary site. Provisional carcinoma of unknown primary (CUP): metastatic epithelial or neuroendocrine malignancy on the basis of biopsy, with no primary site identified, despite initial investigations and before specialist review. Confirmed CUP: as above, after specialist review and appropriate specialised investigations. Patients referred to the CUP MDT will have usually undergone a CT of the chest, abdomen and pelvis. Patients who are unfit for treatment (or who opt against investigation) who have had partial imaging will be discussed to advise on the merits of further investigation. The SWAG NSSG CUP MDTs: Trust CUP MDT CUP MDT Day / Time MDT referral deadline Lead clinician to contact for advice Royal United Hospital Bath NHS Foundation Trust (RUH) RUH Tanya Tillet Taunton and Somerset NHS Foundation Trust (TST) TST Saiqa Spensley Yeovil District Hospital NHS Foundation Trust (YDH) YDH 13:00 14:00 Monday 12:00 Matthew Sephton, 01935 384869 Weston Area Health NHS Trust (WAHT) UH Bristol Thursday morning 8.30 08:00 Thomas Wells, 01934636363, ext. 3990
North Bristol NHS Trust UH Bristol Thursday morning 8.30 08:00 University Hospital Bristol NHS Foundation Trust (UH Bristol) UH Bristol Thursday morning 8.30 08:00 Anna Kuchel Gloucestershire Hospitals NHS Trust (Glos) Glos CUP service is currently in set-up. Referrals are made to at present David Farrugia Referral processes: Royal United Hospital Bath NHS Foundation Trust (RUH) Primary care referral: Referral from cancer site specific MDT: Taunton and Somerset NHS Foundation Trust (TST) Primary Care referral: Referral from cancer site specific MDT: Yeovil District Hospital NHS Foundation Trust (YDH) Primary Care referral: Referral from cancer site specific MDT:
Malignancy of Unknown Origin (MUO) Assessment Form Please complete for each patient referred from Primary Care or as an inpatient Patient Name Hospital Number DOB Contact telephone number Source of Initial Referral Initial Referring Investigation Presenting Symptoms Performance Status CT Chest/Abdo/Pelvis MRI scan (if needed) Routine Bloods Tests (FBC, U&Es, LFTs, Ca 2+, LDH) Relevant Tumour Markers Myeloma Screen Endoscopy (if relevant) Biopsy Site Other CUP MDT CUP MDT Outcome
Malignancy of Unknown Origin (MUO) Assessment Form Initial Oncology OPA Dr Definitive Oncology OPA Dr Confirmed Diagnosis Treatment Plan Notes University Hospital Bristol NHS Foundation Trust (UH Bristol) Primary Care referral Referral from cancer site specific MDT University Hospitals Bristol NHS Foundation Trust CANCER OF UNKNOWN PRIMARY MDT Request Form of MDT Patient Name DOB Patients location NHS No. Hospital No. Consultant Referred by Referrers contact number of Referral to CUP team How was patient referred to BRI Referral date to BRI
Performance Status (see 2 nd page for guidance) Key worker History and presenting symptoms Investigation of investigation Place of investigation Radiology - Specify Tumour Markers Biopsy Cytology Current issue for MDT discussion: Guidance Notes Referrals: Requests for MDT discussion should be made by email to the CUP Team email address by 8am on a, prior to MDT discussion on Thursday. Please send with any attachments that you may think the MDT will find useful, e.g. referral letters. The email address is ubhtr.cupteam@nhs.net Contact: Janette.tucker@uhbristol.nhs.uk Tel: 0117 3421294
Performance Status (WHO Scale) WHO Grade Assessment 0 Able to carry out all normal activities without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out light work 2 Ambulatory and capable of all self-care but unable to carry out any work: up and about more than 50% of waking hours 3 Capable of only limited self-care: confined to bed or chair more than 50% of waking hours 4 Completely disabled: cannot carry out any self-care: totally confined to bed or chair Gloucestershire Hospitals NHS Trust (Glos) Primary Care referral Referral from cancer site specific MDT