Brain and CNS Cancer

Services

Bedford Hospital NHS Trust

Brain & Central Nervous System (CNS) Cancer Services

Brain & Central Nervous System (CNS) cancer services at Bedford Hospital are provided by the Brain/CNS Team.

The Brain/CNS Team

Consultant
Dr M Manford  01234 355 122 ext: Mark.Manford@bedfordhospital.nhs.uk

Outpatient Appointments

Following referral under the 2 week rule, patients will be seen in outpatients by a Consultant or another member of the team with 1-2 weeks
Outpatient clinics take place:

Day Morning Afternoon
Monday - -
Tuesday - -
Wednesday - -
Thursday - Dr Manford
Friday - -

Who to Refer

All patients can be referred; particularly those covered by the Anglia Cancer Network area - NHS Bedfordshire residents in North & East Bedfordshire.

Urgent Referral within 2 Weeks (under 2 week rule)

Refer urgently patients with:

  • Symptoms related to the CNS, including:
    • Progressive neurological deficit
    • New-onset seizures
    • Headaches
    • Mental changes
    • Cranial nerve palsy
    • Unilateral sensorineural deafness in whom a brain tumour is suspected
  • Headaches of recent onset accompanied by features suggestive of raised intracranial pressure, for example:
    • Vomiting
    • Drowsiness
    • Posture-related headache
    • Pulse-synchronous tinnitus or by other focal or non-focal neurological symptoms, for example blackout, change in personality or memory
  • A new, qualitatively different, unexplained headache that becomes progressively severe
  • Suspected recent-onset seizures (refer to neurologist)

Consider urgent referral (to an appropriate specialist) in patients with rapid progression of:

  • Subacute focal neurological deficit
  • Unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these
  • Personality changes confirmed by a witness and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour.

Non-urgent referral

Consider non-urgent referral or discussion with specialist for:

  • Unexplained headaches of recent onset:
    • Present for at least 1 month
    • Not accompanied by features suggestive of raised intracranial pressure

Risk Factors

Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:

  • Recent onset seizure
  • Progressive neurological deficit
  • Persistent headaches
  • New mental or cognitive changes
  • New neurological signs

Investigations

  • In a patient with new, unexplained headaches or neurological symptoms, undertake a neurological examination guided by the symptoms, but including examination for papilloedema.  Note that the absence of papilloedema does not exclude the possibility of a brain tumour
  • When a patient presents with seizure, take a detailed history from the patient and an eyewitness to the event.  Carry out a physical examination, including cardiac, neurological and mental state, and developmental assessment, where appropriate.

Macmillan Cancer Support Rapid Referral Guidelines

Macmillan Cancer Support Rapid Referral Guidelines

Who not to Refer

Patients outside of the Anglia Cancer Network area are usually referred to Hospitals within their Cancer Network area.  NHS Bedfordshire residents living in North and East Bedfordshire are included under the Anglia Cancer Network.

South Bedfordshire patients are included under the Mount Vernon Cancer Network and usually referred to the Luton & Dunstable Hospital.

Resources

Map of Medicine Patient Pathway

Map of Medicine Patient Pathway

NICE Guidelines:

CG27 Referral for suspected cancer: full guideline
http://guidance.nice.org.uk/CG27/Guidance
CG27 Referral for suspected cancer: quick reference guide
http://guidance.nice.org.uk/CG27/QuickRefGuide/pdf/English
CG27 Referral for suspected cancer: information for the public
http://guidance.nice.org.uk/CG27/PublicInfo/pdf/English
CG27 Referral for suspected cancer: NICE guideline
http://guidance.nice.org.uk/CG27/NICEGuidance/pdf/English

Website Resources

Brain Tumours  NHS Choices:
http://www.nhs.uk/conditions/brain-tumours/Pages/Introduction.aspx
Brain Tumour UK:
http://www.braintumouruk.org.uk/
Samantha Dickson Brain Tumour Trust
http://braintumourtrust.co.uk/
Brain Tumour Research:
http://www.braintumourresearch.org/
NICE Guidelines - Brain Tumours:
http://www.nice.org.uk/guidance/CSGBraincns/Guidance/pdf/English
Macmillan Cancer Support - Brain Tumours:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Braintumours.aspx

Cancer Network

Anglia Cancer Network - for residents from Norfolk, Suffolk, Bedfordshire and Cambridgeshire
http://www.angliacancernetwork.nhs.uk/



Last updated: 24/01/2013

Update due: 24/01/2014