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MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon

MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon. www.bowelcancerwest.org.uk. bowelcancerwest.org.uk. 2 Week Criteria.

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MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon

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  1. MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon www.bowelcancerwest.org.uk

  2. bowelcancerwest.org.uk

  3. 2 Week Criteria ‘everyone with suspected cancer will be able to see a specialist within 2 weeks of their GP deciding that they need to be seen urgently and requesting an appointment’

  4. Where were the delays?

  5. Colorectal cancer 2WW criteria • Rectal bleeding WITH a change in bowel habit to loosened stool and/or increased frequency of defaecation persistent for 6 weeks (all ages) • Change in bowel habit above WITHOUT rectal bleeding and persistent for 6 weeks • Rectal bleeding persistently WITHOUT anal symptoms • A definite right sided abdominal mass • A definite palpable rectal mass (not pelvic) • Iron deficiency anaemia Below 10gms post-menopausal women Below 11gms all men Anal symptoms include soreness, discomfort, itching, lumps and prolapse as well as pain

  6. 80-90% of bowel cancer patients identified by GPs, referred and seen within two weeks The total number of patients referred kept to a minimum and easily accommodated within existing resources Aims – 2 Week Standard 100% effective high efficiency

  7. Age and Symptom Profiles

  8. Diagnostic Yield

  9. Correct Referral

  10. How to Improve GPs Effectiveness and Efficiency

  11. Proportion of Cancer Patients Identified by Higher Risk Criteria Overall 76 / 83 92% TWC 36 / 38 95% Non-TWC 40 / 45 89% Guidelines valid

  12. Take Home Message • Only send patients with: • New symptoms • Persistent symptoms • Need to be aware of the importance of anal symptoms in patients with rectal bleeding

  13. the referral criteria are effective and reasonably efficient • By appropriate use, most cancers can be diagnosed in the 2WW clinic

  14. Key Points for GP Education • Must identify patients with new symptoms • Importance of only referring patients with symptoms persistent for at least 6 weeks • Importance of the absence of anal symptoms in patients with rectal bleeding

  15. Introduction NAEDI Bowel Awareness Campaign 2011 Department of Health’s National Awareness and Early Diagnosis Initiative (NAEDI) www.bowelcancerwest.org.uk

  16. Colorectal 2WW Referrals Received between 1st January and 31st June 2009, 2010 and 2011 30% increase in 2WW referrals www.bowelcancerwest.org.uk

  17. Colonoscopy's Performed between 1st January and 31st June2009, 2010 and 2011 35% increase in colonoscopies www.bowelcancerwest.org.uk

  18. Flexi-signmoidoscopy`s Performed between 1st January and 31st June 2009, 2010 and 2011 17% more flexi sigs www.bowelcancerwest.org.uk

  19. Barium Enem as performed between 1st January and 31st June2009, 2010 and 2011 8% more Barium enemas www.bowelcancerwest.org.uk

  20. CTs Performed between 1st January and 31st June 2009, 2010 and 2011 No increase in CT www.bowelcancerwest.org.uk

  21. Colorectal Cancers Diagnosed between 1st January and 31st June2009, 2010 and 2011 No increase in cancers diagnosed

  22. 2WW 2011-12 PHNT

  23. Take Home Messages • Refer persistent new onset symptoms to 2WW • Family history is useful • We have (relatively) short waiting times for non 2WW • Don’t hesitate to call us!

  24. ANY QUESTIONS?

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