Medical Oncology

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    Brain tumour

    • Uncontrolled or disabling pain
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Febrile neutropenia

    Breast cancer

    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Febrile neutropenia

    Cervical cancer

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Malignant bowel obstruction
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia

    Colorectal cancer

    • Significant bleeding –severe gastrointestinal 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)
    • Malignant bowel obstruction
    • Febrile neutropenia

    Endometrial cancer

    • 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)
    • Malignant bowel obstruction
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia

    Gastro-Oesophageal cancer

    • Significant bleeding – including severe gastrointestinal bleeding or melena.
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Malignant bowel obstruction
    • Febrile neutropenia

    Head and neck cancer

    • Significant bleeding – including haemoptysis
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Febrile neutropenia

    Hepatocellular (Live) cancer

    • 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
    • Febrile neutropenia

    Lung cancer

    • Significant bleeding – including haemoptysis
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)

    Melanoma

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)

    Ovarian cancer

    • 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)
    • Malignant bowel obstruction
    • Febrile neutropenia

    Pancreatic-Biliary cancer

    • 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

    Prostate cancer

    • Significant bleeding – including haematuria particularly with clot retention.
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia calcium (>3.0mmol/L)

    Sarcoma (Bone or Soft tissue) cancer

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptomatic malignant hypercalcaemia
    • Suspected tumour lysis syndrome
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Febrile neutropenia

    Testicular cancer

    If symptomatic from volume of disease or CNS metastases, should discuss with medical oncologist on call or ED presentation

    • Significant bleeding
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Symptomatic malignant hypercalcaemia
    • Suspected tumour lysis syndrome
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Acute urinary retention or ureteric obstruction secondary to malignancy
    • Febrile neutropenia

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC exclusions section.

    • For patients with a confirmed or in specific cases (outlined below) suspected diagnosis of cancer to be assessed and treated for cancer. Care is provided for a range of different cancer types in the outpatient clinics are generally according to type of cancer i.e. Breast Cancer, Gastrointestinal Cancer, Hepato-biliary Cancer, Lung Cancer, Genitourinary Cancer, Gynaecological Cancer, as well as other less common types of cancer.
    • For patients to be considered for cancer clinical trials.
    • For patients having been treated in the past for cancer and presenting with survivorship issues relating to previous diagnosis or treatment.

  • The following are not routinely provided in a public Medical Oncology service.

    • Lymphoma, Leukemia and blood disorders: please refer to Haematology
    • Patients requiring surgery for cancer: refer to subspecialty surgical service
    • Patients not aware of diagnosis or likely diagnosis (without explanation)
    • Consultations cannot occur without the patient present
    • Unwell patients requiring acute hospitalisation are not suitable for outpatient referral
    • This is not a diagnostic pathway so patients with suspected but not confirmed malignancy should be referred to the most relevant sub-specialist for investigation and confirmation of a malignant diagnosis.
    • It is recommended that patients presenting with the following conditions should be referred directly to their local emergency department for inpatient investigation and management to expedite their care requirements:
      • Significant bleeding – including haemoptysis, severe gastrointestinal bleeding, and haematuria particularly with clot retention.
      • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
      • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
      • Suspected spinal cord compression or cauda equina syndrome
      • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
      • Symptomatic malignant hypercalcaemia
      • Suspected tumour lysis syndrome
      • 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
      • Acute urinary retention or ureteric obstruction secondary to malignancy
      • Febrile neutropenia

Last updated: 24 January 2025

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