NICE summaries

The fact that the National Institute of Clinical Excellence has its own official biscuits does not bode well for the quality of its recommendations on obesity...

The purpose of this page is to allow you to quickly brush up on the relevant NICE guidance in common areas, split up by common topics body system/pathologies. Try to memorise them all in one sitting (really - don't do this)...

Cancer is a huge topic, affecting every organ system, so I've dropped the guidance into each sub section...

Breast

Breast cancer

Breast clinic under a 2WW for anyone:

• Over 30 with a concerning breast lump with or without pain.
• 50+ with nipple changes or discharge.

Consider 2WW referral for anyone

• With skin changes that suggest breast cancer
• 30+ with axillary lump with no obvious cause.

GI

Upper GI cancer

You will want to refer via 2WW anyone with an upper abdominal mass that suggests stomach cancer, or anyone over 40 with jaundice.

Send for urgent OGD

• Dysphagia
• 55+ with weight loss and pain/reflux symptoms.

Send for non-urgent OGD

• Haematemesis
• 55+ with:
  • Non resolving dyspepsia.
  • Upper abdo pain and anaemia
  • Raised platelets with any upper GI symptoms
  • Nausea and vomiting with weight loss/reflux/pain

Send for urgent CT

Anyone who is 60+ with weight loss and any of these:

• Diarrhoea or constipation
• Back pain
• Abdominal pain
• Nausea/Vomiting
• New diabetes

Some of these are a bit odd, because you would probably already be sending on a Lower GI cancer referral...

Consider urgent USS

Anyone who has a mass that feels like an enlarged liver or gallbladder mass deserves a cheeky USS.

Lower GI cancer

It's 2WW time for any of the following:

• Any age with unexplained anal mass or ulceration.
• 40+ with weight loss and abdo pain
• 50+ with unexplained rectal bleeding
• 60+ with iron deficiency anaemia or changes in bowel habit.
• Positive FOB test.

Consider 2WW referral

• Any abdominal mass
• Younger than 50 with rectal bleeding plus:
  • Abdominal pain
  • Change in bowel habit
  • Weight loss
  • Iron deficiency anaemia

Offer FOB testing

• 50+ with abdominal pain +/- weight loss.
• Less than 60 with change in bowel habit or iron deficiency anaemia.
• More than 60 with any anaemia.

Urology

Male Stuff

Refer any of the following via 2WW:

• Lumpy scary-feeling prostate on DRE.
• PSA above the age specific range (Generally anything much over 5).
• Painless enlargement or change in testicle shape.
• Firm penile mass or ulceration after STI excluded/treated.

Consider DRE and PSA test

• Any urinary symptoms, such as urgency, frequency, nocturia, etc.
• Erectile dysfunction
• Visible haematuria

Exclude UTI with these too.

Consider USS

• For any unexplained or unusually persistent testicular symptoms.

Respiratory

Lung cancers

In

anyone with a suggestive CXR, or anyone over 40 with unexplained haemoptysis you need to refer them through 2WW.

Otherwise, consider:

Urgent CXR if over 40 and 2 of these:

• Significant smoking/asbestos history
• Cough
• Fatigue
• SOB
• Chest pain
• Weight loss or loss of appetite

Consider urgent CXR if over 40 and

Anything weird, such as recurrent chest infections, clubbing, neck or supraclavicular lymphadenopathy or weird chest findings on examination.

Sexual Health

Pregnancy