Pancreatic-biliary Cancer
Emergency department referrals
Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.
Contact on call Oncology Registrar through:
- Royal Brisbane & Women’s Hospital (07) 3646 8111
- The Prince Charles Hospital (07) 3139 4000
- Redcliffe Hospital (07) 3883 7777
- Caboolture Hospital (07) 5433 8888
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- Significant bleeding
- Uncontrolled or disabling pain or severe uncontrolled dyspnoea
- Symptomatic malignant hypercalcaemia
- Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
- Biliary obstruction from suspected malignant disease
- Malignant bowel obstruction
- Febrile neutropenia
- Acute onset jaundice from suspected malignancy biliary obstruction
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
Patients with suspected pancreatic or biliary tract cancer should be referred to the General or Hepato-biliary surgical team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.
Patients with Multiple pancreatic cysts or IPMNs for investigation or surveillance should be referred to the General or Hepato-biliary surgical team.
- Neoadjuvant chemotherapy prior to surgery (usually referred by Surgeon after MDT). For optimum care, patient should be seen within 2 weeks.
- Adjuvant treatment after surgery (usually referred after MDT by surgeon)
- Metastatic or locally advanced unresectable pancreatic or biliary cancer with rapid progression of symptoms or organ dysfunction. For optimum care, patient should be seen within 2 weeks.
Category 2
Appointment within 90 days is desirable
- Transfer of care from another health service
- Pancreatic ductal adenocarcinoma or cholangiocarcinoma in continuous remission for ≥3 years
Category 3
Appointment within 365 days is desirable
- No category 3 criteria
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Other important information for referring practitioners
- Refer to local HealthPathways or local guidelines
- Refer patients with acute obstructive jaundice with suspected primary pancreatic and biliary malignancy through to the Emergency department to expedite management and for further investigation.
- If the referring clinician organises a biopsy – a core or excisional biopsy is preferable to an FNA if available
- Patients with some stages of pancreatic cancer may receive chemotherapy or chemotherapy and radiation as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the General or Hepato-biliary surgical service, not medical oncology.
- Serum tumour bio-markers such as CEA, CA19.9 or others should not be used as diagnostic tests
- For women and men who have not completed their family, fertility preservation needs to be discussed
- For patients with incurable (metastatic or recurrent) cancer consider the following:
- documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women’s and men’s prognosis and their understanding of their prognosis
- whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
- specific patient goals and values that may impact on treatment choices
- whether the patient has been referred to a palliative or supportive care service
Referral requirements
A referral may be rejected without the following information.
- Detailed history of present signs and symptoms
- Past medical history/pertinent social history
- Current medications and allergies
- Histology report
- FBC, U&E, LFT, LDH results
- CT abdomen report
Additional referral information (useful for processing the referral)
- Other available imaging
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org