Care pathways
5.5 Patients with cancer enter the hospital by a number of routes. For some the suspicion of cancer is high when they are first seen by a GP.
These patients should be referred urgently for assessment. Others are referred as an emergency (e. g. because of bowel obstruction). In other cases cancer may not initially be suspected. The common factor is that whenever the suspicion of cancer emerges, the patient wants to feel confident that the subsequent stages of diagnosis and treatment will follow as soon as possible.
5.6 The steps required for diagnosis differ for different cancers. For example:
- Patients with breast cancer most frequently present with a breast lump. The essential steps for diagnosis (clinical assessment, imaging and biopsy) can normally be completed at a single visit.
- Patients with stomach cancer usually present with symptoms of indigestion and related symptoms. Diagnosis is most frequently made on a biopsy taken at gastroscopy. Additional investigations such as CT scanning are likely to be needed to assess the stage of the disease and thus the most appropriate treatment option.
- Patients with lung cancer are often referred initially by their GP for a chest x-ray because of prolonged cough, breathlessness or other symptoms. The chest x-ray may indicate the probability of lung cancer, which is then confirmed at bronchoscopy. CT scanning and other investigations may be needed to determine the most appropriate treatment.
5.7 Each patient will need the pathway of care that is right for them. But every patient will want to know that they are moving swiftly through the right steps to ensure an accurate diagnosis and the most appropriate treatment. Both clinicians and patients want the prospect of waits of days rather than weeks between each step in the cancer pathway of care. Patients also want clear information about what is to happen at each step, and when. And they want support in making their own choices about timing - perhaps to take a little time to come to terms with what is happening to them and to consider options for treatment, or to plan treatment around an important family event. They want to be confident that services will be there as soon as they need them, and they want the arrangements to be personalised around their own circumstances and particular clinical needs.
