When did you last diagnose cancer in A and E?
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When did you last diagnose cancer in A and E?
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One in four people with cancer is diagnosed in A and E accoding to the National Cancer Intellgence Network. The NCIN's figures come from a study of 739,667 people who were diagnosed in Engl
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Forums » Open clinical » General clinical » When did you last diagnose cancer in A and E?
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When did you last diagnose cancer in A and E?
posted at 21/9/2012 11:20 AM BST
on bmj.com
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*Moderator*
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First: 17/11/2008 Last: 19/5/2013 |
One in four people with cancer is diagnosed in A and E accoding to the National Cancer Intellgence Network. The NCIN's figures come from a study of 739,667 people who were diagnosed in England in 2006-2008. The study is reported to be in the British Journal of Cancer but I can't find it. So I've only got the news reports to go on. Apparently it was cancers of the brain and CNS (?) and pancreas and lung that were commonly found. The statistics have been met with horror by McMillan, the cancer charity, whose chief medical office, Prof Jane Maher, was quoted as saying: "It is appalling that so many cancer patients are still diagnosed through emergency admissions, with 65% of them over 70 " |
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Re: When did you last diagnose cancer in A and E?
posted at 21/9/2012 12:52 PM BST
on bmj.com
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Posts: 322
First: 12/11/2010 Last: 20/5/2013 |
I have pteviously diagnosed haematological malignancy in my lipid clinic. They arrived in OPD, in an early neutropenic crisis and no one had previously considered a tumour.. You can easily see how lung cancers, bowel obstructions, and a whole host of cancers will appear in A&E, |
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Re: When did you last diagnose cancer in A and E?
posted at 21/9/2012 2:47 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
I have diagnosed a case in of CA Larynx in the routine OPD. But here the clinical picture was characteristic. Generally the patients present in their late stage, hence generally are detected more often in A & E. It is not that it reflects badly on the diagnostic ability of GPs. |
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Re: When did you last diagnose cancer in A and E?
posted at 21/9/2012 4:26 PM BST
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
We find a *lot* of lung cancer in the ED (As they like to call it now, A&E is so 20th century). People wait and wait and wait and.... collapse and come to the ED. CXR - cancer. I've diagnosed MS in my chest clinic, IHD and osteo-artiritis requiring a TKR in my CF clinic, and hyper-thyroidism in my asthma transition clinic. Amazing what you see if you keep your eyes, ears, and mind open.
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Re: When did you last diagnose cancer in A and E?
posted at 21/9/2012 7:00 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
I still call it Casualty, so 19th Century. It was Casualty when I was a Casualty SHO in the 1970s . As DundeeChest says if an elderly person attends in a cachexic state and in a 'collapsed' state then cancer has to be in the differential diagnosis. I cant remember diagnosing a lot of cancers during my six months as a Casualty SHO. With an aging population the Uk will tend to get more neoplastic and degenerative disease. Patients still have the choice of presenting symptoms to Doctors but are free not to present them. I do try to look for cancers early, but sometimes with the treatments I wonder if I have helped some patients by early diagnosis. I am not in favor of additional 'cancer screening ' unless mortality is significantly improved by the screening. Ah well retirment in only a few years. |
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Re: When did you last diagnose cancer in A and E?
posted at 21/9/2012 7:20 PM BST
on bmj.com
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Posts: 2049
First: 12/3/2010 Last: 22/5/2013 |
If I may extend this (as DC has) beyond cancer to critical conditions, I have been surprised by the number of patients that pre-operative assessment turns up with critical aortic stenosis. I, or rather one of the nurses, found one just the other day, with a full house of signs, but who felt fine, apart from some SOBE that they attributed to age and obesity. Off to cardiology for you, forget the general surgical condition. Another turned up who had moved to our area after many anaesthetics for a recurring surgical condition, who had been lost to follow-up at the previous hospital and presented to us 18 months after the last GA. POA, murmur, rapid echocardiogram and the discovery of AoS with a gradient of 109mmHg! I assume that someone at St.Elsewhere's did listen to their heart, and I know that AoS can be rapidly progressive, but in 18/12! John |
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Re: When did you last diagnose cancer in A and E?
posted at 22/9/2012 6:57 AM BST
on bmj.com
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Posts: 876
First: 17/6/2011 Last: 22/5/2013 |
Definitely not in 18/12 for that degree of AS. As far as I can see two things happen - one is that people will temporise until they feel really awful and I guess for a GP picking up the serious symtoms in 10 minutes is a challenge. My prize diagnosis of the week was a carcinoma of the transverse colon that had eroded the stomach wall in heart failure clinic! sadian ps he had had iron deficiency anaemia for about 6 months with no investigation |
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Re: When did you last diagnose cancer in A and E?
posted at 23/10/2012 10:00 AM BST
on bmj.com
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*Moderator*
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First: 7/4/2011 Last: 22/5/2013 |
And now we have the news that 25% of bowel cancer diagnoses are made after emergency admission http://www.bmj.com/content/345/bmj.e7117 Nigel Scott, a colorectal surgeon at the Royal Preston Hospital and the audit’s lead said these patients are often elderly and living alone, and that the "failure to refer patients with symptoms that could indicate bowel cancer did not seem to be the major reason for diagnosis after emergency admission." |
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Re: When did you last diagnose cancer in A and E?
posted at 23/10/2012 10:21 AM BST
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
Bowel cancer, and lung cancer, present late, because no-one can see their own insides. Both are attractive targets for screening programs in this regard; bowel cancer screening is commonplace, lung cancer screening still in the trial stages. I think the referal time from GP to secondary care is rarely the limiting factor in either - weight loss, persistent cough, haemoptysis, chest pain, current smoker will trigger a referral from any GP. it's getting the patient to the GP in the first place that's tough.
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