guidelines for the management of urological cancer - Merseyside ...

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Appendix 4 PELVIC SPECIALIST MDT REFERRAL PROFORMA PELVIC SPECIALIST MDT REFERRAL PROFORMA FAXBACK NUMBER: 0151 706 2313 PATIENT DETAILS PATIENT ID ___________________ DOB _________________________ Postcode _____________________ Name ________________________ REFERRER DETAILS NAME: TELEPHONE NO: FAX NO: DATE OF REFERRAL: GP DETAILS Name ___________________ Postcode _____________________ Address_______________________ RADIOLOGIST / PATHOLOGIST REVIEW REQUEST N.B Images must be received at the latest by Wednesday before the meeting. Radiology to be reviewed? If so, specific Pathology to be reviewed? question to be asked: Films referred to (SMDT Radiologist) Date: Slides referred to (SMDT Pathologist) Date: Histological grade and stage Clinical stage BLADDER CANCER - CHECKLIST PRIOR TO REFERRAL U & Es LFTs MRI CT scan Co-morbidity / medication Upper Tract Status No Hydronephrosis Unilateral Hydronephrosis Bilateral Hydronephrosis Question Decision Page 36 of 44
Appendix 5 - TCC Algorithm: New Non-muscle Invasive Tumour First TURBT Non Muscle invasive Muscle Invasive See Muscle invasive algorithm G1pTa / G2pTa G2pT1 G3pTa, G3pT1 or CIS Local MDT Single dose of intravesical chemo at resection Flexi cysto at 3/12 (GA or Flexi) Assign risk group at first cystectomy Solitary tumour initially Local MDT 6x weekly intravesical chemotherapy 1 st check cysto under GA at 4/12 then 3/12 flexis for 2 years, then 6/12 for 2 years, then annual for life Multifocal tumour initially SMDT Pathology review by experienced uropathologist Consider 2 nd look TURBT BCG Consider cystectomy Clear Recurrence Clear Recurrence Low Risk Flexi at 1 year then annually for 5 years as per EAU Guidance. Then annual urine cytology analysis by GP Medium Risk 3/12 flexis for 1 year then 6/12 flexis for 3 years then annual flexis for life High Risk 6 doses of intravesical chemo then 3/13 flexi for 1 year then 6/12 flexi for 2 years then annual flexi for life BCG protocol Induction course 6 weeks with GA cysto and biopsy 8/52 after maintenance schedule as agreed local protocol. Monitoring 3/12 flexi for 2 years then 6/12 for 3 years then annually for life Page 37 of 44
Page 1 and 2: GUIDELINES FOR THE MANAGEMENT OF UR
Page 3 and 4: Appendix 1 - SMDT contacts Appendix
Page 5 and 6: 1.2 Definition of Terms Carcinoma i
Page 7 and 8: Patients with haematuria may have a
Page 9 and 10: 4. ASSESSMENT OF IDENTIFIED BLADDER
Page 11 and 12: 5.1 Referral to the SMDT 1. It is t
Page 13 and 14: For patients referred from the loca
Page 15 and 16: 6.1 Page 15 of 44
Page 17 and 18: 6.1 Page 17 of 44
Page 19 and 20: 6.2 Recurrent Non-muscle Invasive T
Page 21 and 22: 6.52 Radiotherapy Radical RT Fit p
Page 23 and 24: All patients will be offered clear
Page 25 and 26: References 1. Tolley DA, Parmar MK,
Page 27 and 28: 28. Madersbacher S, Hochreiter W, B
Page 29 and 30: Appendix 2 - Referral Form Referrin
Page 31 and 32: Non-urgent referral • Refer non-u
Page 33 and 34: ‘Unexplained’ as used in the re
Page 35: Appendix 3 - TNM Classification of
Page 39 and 40: Appendix 7 - TCC Algorithm: Muscle
Page 41 and 42: Appendix 9 - Radiology Guidelines M
Page 43 and 44: Specific Anatomic Region Applicatio

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