The Royal Marsden. 2 WW Referrals. Mr Alan Thompson Consultant Urological Surgeon The Royal Marsden

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1 The Royal Marsden 2 WW Referrals Mr Alan Thompson Consultant Urological Surgeon The Royal Marsden

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4 4 Office for National Statistics 2012

5 5 CRUK

6 6 CRUK

7 7 The Royal Marsden No obvious preventable factors though obesity? higher BMI may be diagnosed later stages 1:8 lifetime risk Age and race Genetics (Height/male pattern baldness/lynch syn) Father 2.1 to 2.4 x Brother 2.9 to 3.3 x Mother breast Ca approx 25% higher Decreased risk -? Parkinsons/DM/HIV/exercise

8 8 The Royal Marsden Obvious preventable factors - Smoking 37% - Occupational 6% - Ionising radiation 3% Genetics 1 st degree rel 1.8 x (poss due to shared smoke exposure) Brother 2.9 to 3.3 Mother breast Ca approx 25% higher Decreased risk -? Parkinsons/delayed menarche or menopause/exercise

9 9 The Royal Marsden Obvious preventable factors - Smoking 50% higher I smokers - Obesity (BMI 30) 63% higher in men / 95% higher in women Genetics 2-4 % are inherited Height 23% increase per 10cm! Parkinsons increases risk

10 10 The Royal Marsden No obvious preventable factors but.. Undescended testicle x 3-6 (Diethylstilboestrol) HIV/Aids 35-79% increase but maybe not with retrovirals Previous testicular tumour risk 12 x Age 80% occur < 50 years Genetics White > black or asian origin Father - 4 x Brother 8 x Height % per 5 cm increase

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12 12 I m getting old, Jim. Today instead of jumping, I had to stretch gently to a conclusion.

13 The Royal Marsden New guidelines (2015) - Prostate Refer using suspected cancer pathway for prostate cancer if the prostate feels malignant on digital rectal examination Consider PSA test in visible haematuria Refer using suspected cancer pathway if their PSA levels are above the age-specific ref range

14 The Royal Marsden New guidelines (2015) - Bladder Refer using a suspected cancer pathway for bladder cancer if they are over 60 years and have unexplained non-visible haematuria and either dysuria or raised white blood cell count on a blood test Consider non-urgent referral for bladder cancer in people over 60 with recurrent or persistent urinary tract infection

15 The Royal Marsden New guidelines (2015) Renal & Testis Refer using suspected cancer pathway if over 45 and have visible haematuria that persists or recurs after successful treatment of urinary tract infection Consider a suspected cancer pathway for testicular cancer in men if they have a non-painful enlargement or change in shape or texture of the testis Consider a direct access ultrasound scan for testicular cancer in men with unexplained testicular symptoms

16 16 The Royal Marsden Changes to NICE Guidelines Symptom thresholds lowered Any symptom that has 3% chance or more of being cancer Children and young adults Guidance organised by signs and symptoms GPs recommended to refer directly for tests e.g. CT and endoscopy Very urgent referrals for some symptoms - < 48hrs Specific recommendations on safety netting (investigations reviewed and acted upon with ordering healthcare professional taking/passing on responsibility/ review of those who don t meet criteria but with symptoms of )

17 17 The Royal Marsden Impacts of changes in NICE Guidance Significant increase in referrals with cost implications Further investment in NHS essential to support this Wider benefits Reduced emergency presentations Decreased treatment costs for patients diagnosed earlier

18 18 The Royal Marsden Benefits of updated Guidance Earlier diagnosis leading to longer survival Reduction in cancers diagnosed by the emergency route Optimised diagnostic processes More appropriate referrals to secondary care for suspected cancer

19 19 The Royal Marsden Impacts on Suspected Cancer Referrals Significant resource impact likely in (30% of all suspected cancer referrals 2013/14) Lung and pleural cancers Upper GI tract cancers Lower GI tract cancers Others no significant changes

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22 22 Wind up your presentation he s losing bone mass

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25 25 And now over to one of our so-called experts