HNY Policy and Pathway Repository - York

Group 1 symptoms suggestive of MSCC with neurological symptoms and/or signs:

• Neurological symptoms including radicular pain, any limb weaknesses, difficulty in walking, sensory loss or bladder or bowel dysfunction
• Neurological signs of spinal cord or cauda equina compression

Group 2 symptoms suggestive of spinal metastases without neurological symptoms and/or signs:

• Pain in middle (thoracic) or upper (cervical) spine
• Progressive lower (lumbar) spinal pain
• Severe unremitting lower spinal pain
• Spinal pain aggravated by straining (eg at stool/coughing/sneezing)
• Localised spinal tenderness
• Nocturnal spinal pain preventing sleep

• All patients with suspected MSCC & neurological symptoms should have an MRI within 24hrs.
• If MSCC is confirmed treatment must be started within 24 hours.
• All patients with confirmed MSCC will be referred to LEEDS where they will be assessed for both radiotherapy and surgery.

Group 1 symptoms suggestive of MSCC with neurological symptoms and/or signs:

• Neurological symptoms including radicular pain, any limb weaknesses, difficulty in walking, sensory loss or bladder or bowel dysfunction
• Neurological signs of spinal cord or cauda equina compression

If has group 1 symptoms follow these steps:

1. Telephone MSCC Co-ordinator (Chemo line) between 8.30am and 5pm on (01904) 726516, between 5pm and 8.30am on (01904) 726031
2. Patient to attend for urgent assessment. on AMU.
3. D/W Duty Consultant Radiologist if suspicious of MSCC
4. Spinal pain suggestive of spinal metastases and neurological symptoms/signs suggestive of MSCC. Give a stat dose of Dexamethasone 16mg oral plus a PPI. The following day to start dexamethasone 8mg 8am and 2pm Ensure patient has adequate pain relief to facilitate lying flat for MRI scan. MRI must be performed within 24hrs
5. MRI positive for SCC. Radiologist to inform co-ordinator.
6. Contact on call Clinical Oncology SpR at St. James’s (Leeds) (0113 2433144) urgently. The MRI & most recent CT scans must be sent electronically. Complete MSCC referral form (under cancer services on staff room)
7. Begin discharge planning on admission Arrange 6/52 OPA

 

Group 2 symptoms suggestive of spinal metastases without neurological symptoms and/or signs:

• Pain in middle (thoracic) or upper (cervical) spine
• Progressive lower (lumbar) spinal pain
• Severe unremitting lower spinal pain
• Spinal pain aggravated by straining (eg at stool/coughing/sneezing)
• Localised spinal tenderness
• Nocturnal spinal pain preventing sleep

If has group 2 symptoms follow these steps:

1. Telephone MSCC Co-ordinator (Chemo line) between 8.30am and 5pm on (01904) 726516, between 5pm and 8.30am on (01904) 726031
2. Review by Consultant Oncologist as outpatient
3. MRI next available urgent slot

• ​​​MRI negative for SCC
  • ​​​​​​​Further investigation and/or referral Analgesia as required

• MRI positive for SCC. Radiologist to inform co-ordinator 
  • Contact on call Clinical Oncology SpR at St. James’s (Leeds) (0113 2433144) urgently. The MRI & most recent CT scans must be sent electronically. Complete MSCC referral form (under cancer services on staff room) 
  • Begin discharge planning on admission (in normal working hours) Arrange 6/52 OPA