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Lca Hepato-Pancreato-Biliary Cancer Clinical Guidelines

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Lca Hepato-Pancreato-Biliary Cancer Clinical Guidelines LCA Hepato-pancreato- biliary Cancer Clinical Guidelines November 2014 LCA HEPATO-PANCREATO-BILIARY CANCER CLINICAL GUIDELINES Contents Introduction ...................................................................................................................................................... 6 Executive Summary ........................................................................................................................................... 8 1 Referrals ...................................................................................................................................................... 9 1.1 Referral for patients with suspected HPB cancer ............................................................................ 9 2 Initial Assessment of Patients with Suspected HPB Cancer ...................................................................... 10 2.1 History and performance status .................................................................................................... 10 2.2 Full examination ............................................................................................................................ 11 2.3 Nutritional assessment .................................................................................................................. 11 2.4 Blood tests ..................................................................................................................................... 11 2.5 Imaging .......................................................................................................................................... 12 2.6 Pathology ...................................................................................................................................... 13 2.7 Pre-assessment for potential treatment options .......................................................................... 14 3 Referral for Patients with a Diagnosis of HPB Cancer ............................................................................... 16 3.1 Referrals to the specialist multidisciplinary team ......................................................................... 16 3.2 Information to include on referrals ............................................................................................... 16 3.3 Standard information to include in referrals to community specialist palliative care teams ....... 17 3.4 Management of children, teenagers and young adults with diagnosed or suspected HPB cancer .................................................................................................................................... 17 4 Inter-professional Communication between Secondary and Primary Care ............................................. 19 4.1 General principles ......................................................................................................................... 19 4.2 At diagnosis ................................................................................................................................... 19 4.3 Multidisciplinary team discussions and decisions ......................................................................... 20 4.4 Letters from clinics ........................................................................................................................ 20 4.5 Treatment Record Summary ......................................................................................................... 20 5 Multidisciplinary Team Structure ............................................................................................................. 21 5.1 Local diagnostic unit ...................................................................................................................... 21 5.2 Specialist pancreatic centre multidisciplinary team ...................................................................... 22 6 Ensuring Patient-centred Care for All Pathways ....................................................................................... 23 6.1 Enhancing the patient experience ................................................................................................. 23 6.2 Key worker allocation and role ..................................................................................................... 23 6.3 Psychological support .................................................................................................................... 24 2 CONTENTS 6.4 Nutritional support ........................................................................................................................ 24 6.5 Rehabilitation and other therapies ............................................................................................... 25 7 Endoscopic Management of Malignant Bile Duct Obstruction ................................................................. 26 7.1 Introduction .................................................................................................................................. 26 7.2 Initial diagnosis .............................................................................................................................. 26 7.3 The approach to biliary stenting in malignant pancreato-biliary obstruction ............................... 27 8 Pancreatic Cancer ..................................................................................................................................... 30 8.1 Introduction .................................................................................................................................. 30 8.2 Referrals into the multidisciplinary team ...................................................................................... 30 8.3 Treatment options ........................................................................................................................ 31 8.4 Chemotherapy regimens ............................................................................................................... 33 8.5 Radiotherapy ................................................................................................................................. 35 8.6 Follow-up ....................................................................................................................................... 38 8.7 Recurrences ................................................................................................................................... 38 9 Hepatocellular Carcinoma ........................................................................................................................ 40 9.1 Introduction .................................................................................................................................. 40 9.2 Surveillance ................................................................................................................................... 41 9.3 Diagnosis of HCC ........................................................................................................................... 41 9.4 Management by specialist multidisciplinary team ........................................................................ 42 9.5 Patient management options ........................................................................................................ 43 9.6 Radiotherapy ................................................................................................................................. 45 9.7 Systemic therapies ........................................................................................................................ 48 9.8 Specialist palliative care ................................................................................................................ 48 10 Gallbladder Carcinoma ............................................................................................................................. 51 10.1 Introduction .................................................................................................................................. 51 10.2 Presentation and diagnosis ........................................................................................................... 51 10.3 Management by the specialist multidisciplinary team ................................................................. 52 10.4 Management of operable disease ................................................................................................. 54 10.5 Management of inoperable disease .............................................................................................. 55 10.6 Follow-up ....................................................................................................................................... 56 11 Cholangiocarcinoma ................................................................................................................................. 57 11.1 Introduction .................................................................................................................................. 57 3 LCA HEPATO-PANCREATO-BILIARY CANCER CLINICAL GUIDELINES 11.2 Presentation and diagnosis ........................................................................................................... 57 11.3 Management by the specialist multidisciplinary team ................................................................. 58 11.4 Treatment options .......................................................................................................................
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