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Tumour Specific Multidisciplinary Teams and Cancer Networks

A patient may initially be referred for diagnostic tests by their GP to see a specialist at the local hospital or be sent direct to the regional surgical centre.

The regional surgical centre should have formally established links with a network of surrounding district hospitals so that all patients within their network/region should have their cases considered by the regional surgical centre even if the patient never actually attends a clinic at that hospital.

Their case should be considered by meetings of multidisciplinary teams (MDT) of specialists including gastroenterologists, radiologists, surgeons, oncologists, specialist nurses etc who will look at the scans and other test information and decide on the best treatment options and in particular whether the patient may be suitable for surgery. These meetings are usually held once a week to consider all the latest cases. If a patient is seen at a hospital that isn’t the surgical centre their case will first be discussed at the local MDT and then referred on to the regional centre MDT meeting. The patient should then be seen by a specialist at clinic at either the local hospital or surgical centre or both.

If a patient is considered a candidate for surgery they will be referred onto the regional surgical centre if not already under a Consultant at that hospital.

If it is decided that surgery is not possible it is likely that the patient will then remain under the management of the local hospital cancer centre or be referred to another centre providing specialist chemotherapy or radiotherapy and trials. If the patient is not fit enough for treatments such as chemotherapy or radiotherapy they may then return for palliative care under the care of their GP, Macmillan nurses, local hospices etc.

Cancer services are organized within regional cancer networks. http://www.cancer.nhs.uk/networks.htm . The cancer network may not exactly coincide with the network of hospitals serving a regional pancreatic cancer surgical centre however they often do. The cancer network has tumour specific working groups of specialists with patient (or user/carer) representatives who agree the local guidelines for provision of services within the network within the framework of national guidelines eg NICE or DoH. The work of the cancer networks is subject to periodical peer review. These tumour groups may be called “Upper GI” ie include all upper gastorenterological cancers such as oesophageal, gastric (stomach), pancreatic, bile duct and liver or there may be separate groups for HPB and oesophageal plus gastric cancers.