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Hellooo Friend!

Hema Here!

Give me a Big Hi5!

As a Doctor,

Don’t We Have a Crucial Role in the Detection of Cancer?

‘Two- week Referral’  Guidelines is one of the most important tools for this is.

This is one of the topics to freshen up just before your Big Day – CSA***









Star*** marked means –  You need to give more attention!

Get NICE referral guidelines  by clicking HERE.

We can have scenarios either –
To negotiate the plan to be referred for 2ww clinic or
To reassure that there is no need for 2ww referral.

Make sure the Patient understands 

Be unambiguous about the nature of the referral with the patient.
Patients sometimes find out that a clinical suspicion existed only after their hospital appointment.
This is understandably distressing and often leads to anger and shock.

Safety net and follow-up.
Always advise patients to contact you if they have not heard from the hospital within two weeks.
It is good practice to see the patient after the diagnosis to offer emotional and psychosocial support.

Practise as many scenarios with your Trainer and Colleagues!

Top Ten Topics are :

  1. Lung  and
  2. GI – Upper & Lower  —> See sheet 1 of 5. click HERE.
  3. Breast  and
  4. Gynaecological——] Lets see these in this post.
  5. Urology
  6. Haematological
  7. Skin
  8. Head & Neck
  9. Brain&CNS
  10. Bone.

It is important to remember Paediatric cases as it can come not only in CSA but also in our normal surgery!

Now we will look into the 3) Breast and 4) Gynaecology topics here.

Top Ten Important Things in Breast Cases

    1. Explore the problems very, very sensitively.
    2. Explore relevant personal & family history in detail…
    3. Get adequate information to be filled in the referral form.
    4. Familiarize with your local 2ww referral forms.
    5. Remember to offer Chaperone.
    6. Learn to explain clearly how you will be examining her.
    7. In a breast model, Follow a systematic approach in examination. Remember to check for axillary lymph nodes.
    8. Learn how to break the news of suspected cancer sensitively.
    9. Make sure to withhold contraceptive Pill if appropriate.
    10. Check the support system and Arrange follow up.


3. Breast

Remember the Age Criterion – 30 yrs.

3o yrs for 13reast –   in letter B  – My Tip 🙂


Urgent Referral

1. Any Age:
Hard lump/ lump with PMH -Breast cancer.

2. 30 or more yrs:
Lump persist after next periods/ after menopause. ***

3. Less than 30 yrs: (remember the non urgent criterion)
Enlarging/fixed/hard lump/ FH of Breast cancer.

4. Unilateral Eczematous changes (not responding to Rx).

5. Nipple changes – New Distortion/bloody discharge.

6. Males > 50 yrs.***   Unilateral mass/ nipple or skin changes.

Non Urgent   – If Less than 30 yrs,

1. Breast lump***, 2. Persisting Breast Pain.
(Mammography – not recommended).

Now lets see the gynaecological referral criteria.

Very Important for CSA!

4. Gynaecological

Urgent Ultrasound Imaging 

Abdominal or pelvic mass. (not  fibroid/GI/Urological).

2WW Referral if

1. Cervical cancer like appearance on examination.

2. Post Menopausal Bleeding

– Not on HRT

Six weeks after Stopping HRT.***  (My Tip)

– On Tamoxifen*** – (remember to check in drug history)

3. Vulval lump

4. Vulval bleeding due to ulceration.

5. Persistent Intermenstrual Bleeding*** – with negative examination.

You can see how easy to set up a case on these criteria.

So change the stories and make it more interesting while practising for CSA!

Thats all in this post!

It is tooooo much to take in … I know!

The Secret of Success in CSA is to Practise as many scenarios as possible… to remember the age, weeks etc…

Have FUN!

Remember the star *** marked ones!  Practise them!

So we will see the next Topics in the next sheet 3 of 5 🙂 To read now- Click here.

To Your Success,

Hema xoxo.


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