Your urgent assessment in head and neck This leaflet will answer some of your questions about why you have been sent to us for an urgent assessment, and what the tests might involve. If you have more questions, please speak to a doctor or nurse caring for you. Your GP or dentist has asked us to investigate your symptoms. These symptoms can be linked to many common conditions. We need to carry out important tests quickly to rule out the possibility of cancer. This leaflet contains a checklist to help you keep track of which tests you will need and when you will have them. Questions or concerns about your care? Contact the head and neck nurse on the Helpline, t: 020 7188 0802, Monday to Friday, 9am to 5pm
Attending your appointments It is very important that you attend every test. It is only when all your test results are looked at together that we can rule out cancer. Remember to bring a list of current medications with you. Please tell the doctor if you have any allergies, or are on anti-coagulant medication. Please tell us the best telephone number to reach you. What will happen next? Your head and neck doctor will examine you and send you for some tests. Then they will discuss your results with a group of specialist doctors to help make decisions about your care. You will see the doctor for the results of your tests. If your results are normal you will be discharged back to the care of your GP (you may be informed of this by telephone). If your doctor decides that treatment is needed, they will discuss this with you. More tests may be needed at any stage if the doctor thinks more information would be helpful. The hospital may contact you by telephone to ask you to come for tests. Your test checklist Your doctor will choose the best tests for you from the list of tests opposite. These tests are explained in more detail on the following pages. Remember, not all of the tests listed will be necessary for you. 2
Please use this list to keep track of your appointments: Test or appointment Smoking cessation Blood test (Anaemia screen) Blood test (Kidney function) Ultrasound Ultrasound biopsy (FNAC/Core) MRI scan CT scan Barium swallow PET-CT Biopsy/Pan-endoscopy (general anaesthetic) Pre-surgery assessment Dietician team Alcohol care team Is it needed? Appointment date, time 3
What tests might I have? After examining you, the consultant will choose the best tests for your range of symptoms. You will not have all of these tests. Your doctor will explain which tests you need and why. Each test is explained below. CT (computerized tomography) scan A CT scan takes pictures of your body using x-rays, which are put together by a computer to complete very detailed picture of the inside of your body. You may need to have an injection of contrast (coloured) dye to give us more detailed pictures, which may involve having a blood test. PET-CT (positron emission tomography) PET-CT shows us how the tissues in the body are functioning and helps us to identify organs that are not working normally. With PET-CT, we inject a tracer (often a weak radioactive form of sugar) then scan the body. Ultrasound scan An ultrasound scan involves a doctor pressing a small probe against your skin, which uses sound waves to detect changes or abnormalities within the head and neck area. It may also be used to guide a biopsy needle. MRI scan An MRI scan uses a combination of a strong magnet and radio waves to produce detailed pictures of the inside of your body. Your doctor will check if you are suitable for an MRI scan, in case you have any metal or implants in your body. 4
Barium swallow A barium swallow is an examination of the oesophagus (food pipe) and the stomach. These areas of your body cannot normally be seen on x-ray images unless coated in a white liquid called barium contrast, which you are asked to swallow. Blood Tests We will need to take blood tests to check if you are anaemic (too little iron in your body), as this may affect any potential treatment. We may also take blood to check your kidney and thyroid function if needed, and more blood tests may be needed if you are sent for a pre-op assessment before surgery. Getting your results Your consultant will review the results of your tests and will arrange to see you in clinic to discuss what happens next. You may be sent for more tests or require treatment. If you cannot attend any of your tests it is important to contact us Monday to Friday, 9am to 5pm. CT, MRI, ultrasound, barium swallow (XR), t: 020 7188 5542, PET-CT, t: 020 7188 4988 If surgery is required, you may be asked to attend a pre-assessment appointment to ensure that you are fit for surgery. The pre-operative team will assess you and provide support throughout your admission. 5
Taking a biopsy (sample of tissue) Ultrasound-guided biopsy This is a way of taking individual cells or tissue from a lump in your neck using a very fine needle. This is called fine needle aspiration cytology (FNAC). The procedure is done while you are awake, and the area will usually be numbed using a local anaesthetic. Sometimes we may use an ultrasound scanner to help guide the needle into the lump. Sometimes a thicker needle is used to take bigger sample, which is called a core biopsy. If possible, we will perform this during your outpatient visit. What are the benefits? The cells or tissue taken are used to diagnose your lump, and can also be used to help decide treatment. Are there any risks? Complications include: bleeding, pain, bruising, infection and a non-diagnostic sample (not enough cells to make a diagnosis; either requiring a repeat FNAC or alternative procedure). Pan-endoscopy and biopsy We may need to examine the back of your nose, tongue, throat and voice box more fully under general anaesthetic, called a pan-endoscopy. This test may also involve taking some tissue samples. If you need a biopsy, your doctor will explain it to you in more detail, and you will be asked to sign a consent form. 6
Consent asking for your consent We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This says that you agree to have the treatment and you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you. Helping yourself Please stop smoking If you smoke, quitting should already have been discussed with you, and a referral to the smoking cessation (stopping) team made, if needed. For more information about quitting smoking, please call the numbers given in the Contact us section of this leaflet. Stopping smoking will reduce your chances of developing a head and neck cancer. If you are found to have a head and neck cancer, stopping smoking now will improve your chances of being cured, and will also reduce the side effects of any treatment. Eating to be stronger If your nurse or consultant feels you need additional support with your diet and nutrition, they will refer you for an appointment with the dietitian team. Drinking sensibly If your consultant thinks your alcohol intake is affecting your health, they may refer you to the alcohol care team. Drinking too much alcohol could make it harder to diagnose a cancer successfully and may affect your recovery and future health. 7
Contact us Monday to Friday, 9am to 5pm Head and neck nurse helpline, t: 020 7188 0802 Stop Smoking service, t: 020 7188 0995 NHS Smoking Helpline, t: 0300 123 1044 If you cannot attend one of your tests and need to reschedule, or have any questions about what the tests will involve, call one of the numbers on page 5. For more leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.guysandstthomas.nhs.uk/leaflets Pharmacy Medicines Helpline If you have any questions about your medicines, please speak to the staff caring for you or call our helpline. t: 020 7188 8748 9am to 5pm, Monday to Friday Your comments and concerns For advice, support or to raise a concern, contact our Patient Advice and Liaison Service (PALS). To make a complaint, contact the complaints department. t: 020 7188 8801 (PALS) e: pals@gstt.nhs.uk t: 020 7188 3514 (complaints) e: complaints2@gstt.nhs.uk Leaflet number: 4580/VER1 Date published: May 2018 Review date: May 2021 2018 Guy s and St Thomas NHS Foundation Trust A list of sources is available on request 8