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Merseyside and Cheshire Cancer Network HEPATO BILIARY MULTIDISCIPLINIARY TEAM MEETING Referral to Specialist HPB (Liver) PowerPoint Presentation
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Merseyside and Cheshire Cancer Network HEPATO BILIARY MULTIDISCIPLINIARY TEAM MEETING Referral to Specialist HPB (Liver) MDT, University Hospital, Aintree, with suspected Colorectal Liver Metastases.

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slide1

Merseyside and Cheshire Cancer Network

HEPATO BILIARY MULTIDISCIPLINIARY TEAM MEETING

Referral to Specialist HPB (Liver) MDT, University Hospital, Aintree,

with suspected Colorectal Liver Metastases

PART 1: TO BE COMPLETED BY THE REFERRING UNIT. N.B. NO PATIENT WILL BE DISCUSSED WITHOUT FULL DETAILS

Initial Referral Date / /

Date Referred to UHA / /

Referring Consultant

Referring Hospital

Referring Cancer Network SHA

Forename

Surname

DOB

GP

NHS Number

GP Tel.No

PART 2: TO BE COMPLETED BY UHA

Date of 1st MDT / /

Number of Days on Pathway

Presenting Consultant

UHA

2 week rule Yes No

Decision to Treat / /

Treatment Start Date / /

/ /

Initial colorectal cancer Date Operation performed Laparoscopic resection?

Yes No

TNM classification Tumour T0 T1 T2 Node N0 N1 N2 Metastasis M0 M1

T3 T4 T5 MX

Colon tumour localisation Right Transverse Left including sigmoid Rectum

Chemotherapy postNumber of cycles Drugs

colectomy

Yes No 5FU Yes No

Oxaliplatin Yes No

Irinotecan Yes No

Other Yes No

Name product ……………………………....

Diagnosis of suspectedDate Concomitant extra Synchronous

Liver metastases hepatic disease Yes No Yes No

Number Max size …………. mm Localisation: Unilateral

Bilateral

PLEASE ENCLOSE X-rays X-rays reports Primary cancer Details of any co-morbidity

WITH REFERRAL histology

Date of last CEA

CT/MR

.……………. Date: ……………..

Contact name and number Name Tel.No. FAX E-mail

where Specialist HPB MDT

can FAX the MDT decision

back to referring team

SEND PROFORMA WITH CT/MR AND X-RAY REPORTS TO:

The Specialist HPB (Liver) UNIT,

Room 19, GENERAL SURGERY,

UNIVERSITY HOSPITAL AINTREE, LIVERPOOL, L9 7AL. TEL: 0151-529-8515

REFERRAL CANNOT BE ASSESSED WITHOUT CT/MR AND REPORTS

slide2

PART 3: TO BE COMPLETED BY UHA

MDT DecisionPotentially Resectable

Mass Present Yes No

Metastases Immediate Action Planning

Ascites No action here Refer Back

Vascular Yes

Encasement

Nodes

Consultant Radiologists

Dr Smethurst Dr White Dr O’Grady Dr Evans

General Summary

Further InvestigationDate BookedDate CompletedDays on Pathway

CT

MR

CEA

US

EUS

Other

/ /

/ /

Reason for Investigation

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

Date of 2nd MDT UHA

Reason for Discussion

General Summary

Confirmed Diagnosis

Treatment Outcome

/ /

OPD

Admission

Microwave

Best Supportive / Palliative Care

Resection

Preoperative Chemotherapy

Palliative Chemotherapy

RFA

Trials

Date of Recurrence

/ /

slide3

Merseyside and Cheshire Cancer Network

HEPATO BILIARY MULTIDISCIPLINIARY TEAM

Referral to Specialist HPB (Liver) MDT, University Hospital, Aintree,

with suspected primary liver cancer, including cholangiocarcinoma, gall bladder cancer

PART 1: TO BE COMPLETED BY THE REFERRING UNIT. N.B. NO PATIENT WILL BE DISCUSSED WITHOUT FULL DETAILS

Initial Referral Date / /

Date Referred to UHA / /

Referring Consultant

Referring Hospital

Forename

Surname

DOB

Inpatient Outpatient

Presenting Symptoms and Relevant History

Bloods CLINICAL QUESTION

ALK PHOS ALT CA19.9 AFP

BILIRUBIN GGT CEA

Histology (please include details of any relevant histology e.g. brushings). DO NOT BIOPSY LIVER LESIONS, REFER TO HPB SPECIALIST MDT FIRST

ALL RELEVANT IMAGING (INCLUDING ERCP FILM) AND RADIOLOGISTS REPORTS ARE ENCLOSED WITH THIS REFERRAL

PART 3: TO BE COMPLETED BY UHA SUMMARY OF MDT1

MDT DecisionPotentially Resectable

Mass Present Yes No

Metastases Immediate Action Planning

Ascites No action here Refer Back

Vascular Yes

Encasement Discussed by:

Nodes

Consultant Radiologists

Dr Smethurst Dr White Dr O’Grady Dr Evans

Contact Details of Referrer where MDT Decision can be faxed:

Name: Fax: Tel No.

SEND PROFORMA + REFERRAL LETTER WITH CT/MR/ERCP AND X-RAY REPORTS TO: The Specialist HPB (Liver) UNIT,

Room 19, GENERAL SURGERY,

UNIVERSITY HOSPITAL AINTREE, LIVERPOOL, L9 7AL TEL: 0151-529-8515

REFERRAL CANNOT BE ASSESSED WITHOUT CT/MR AND REPORTS

PART 2: TO BE COMPLETED BY UHA

Date of 1st MDT / /

Number of Days on Pathway

Presenting Consultant

Yes No

UHA GP 2 week rule

Decision to Treat / /

Treatment Start Date / /

/ /

slide4

Further InvestigationDate BookedDate CompletedDays on Pathway

CT

US

EUS

EUS / FNA

CT Biopsy

US Biopsy

OPD

Admission

/ /

/ /

Reason for Investigation

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

Date of 2nd MDTUHA

Reason for Discussion

General Summary

Confirmed Diagnosis

Treatment Outcome

/ /

Photodynamic Therapy

Chemoembolisation

RFA

Best Supportive / Palliative Care

Resection

Neo/Adjuvant Chemotherapy

Palliative Bypass

Palliative Chemotherapy

Trials

Date of Recurrence

/ /

Date of 3rd MDTUHA

Reason for Discussion

General Summary

Confirmed Diagnosis

Treatment Outcome

/ /

Resection

Neo/Adjuvant Chemotherapy

Palliative Bypass

Palliative Chemotherapy

Trials

Date of Recurrence

/ /