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Oxford University Hospitals NHS Foundation Trust
Cancer Services

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After referral to the HPB MDT

Referral and first appointments

Once your GP or hospital doctor as referred you, your case history and images will be discussed at the next multidisciplinary team (MDT) meeting, on a Monday at 12.00 noon.

The aim is to have your case discussed as soon as is possible. However, patients referred after 12.00 noon on a Friday are discussed the following week. This is because the consultant radiologist reviewing their images needs to go over all scans carefully prior to the MDT meeting, and this requires time.

A treatment plan is formulated for you following discussion at MDT. We will either see you at the HPB Clinic soon after (usually on the Friday of the same or following week), or we will ask for further tests/investigations to be done so that we can formulate a specific treatment plan.

If needed, these tests will happen either in Oxford or your local hospital. If you can be treated at your local hospital, your local doctor will contact you in due course.

We have dedicated clinics for suspected cancer patients, who are usually seen within one to two weeks of us receiving a referral. Each new patient in the cancer clinic is seen by a consultant surgeon or a senior member of the surgical team for a consultation; first with the surgeon and then the nurse specialist.

The nurse specialist will be your point of contact with the team and will also maintain regular contact with you. You may also need to meet our specialist dietitian and physiotherapist on this day, depending on the management plan you are on.

Further scans and tests

If you require any further scans and tests, these may be arranged for the same day as your visit to clinic in Oxford, if at all possible, especially if you have to travel a long distance to the hospital.

Surgery

If you need cancer surgery, we try our best to give you the earliest available date for surgery. You will also need an additional visit for pre-operative assessment, which may involve meeting with the physiotherapy pre-habilitation team.

Your surgery will take place at the Churchill Hospital. To prevent an unnecessary stay in hospital, if appropriate, we will ask you to come into hospital on the morning of your surgery.

We have a range of patient information leaflets to explain different procedures and treatments, giving you details of what to expect before, during and after your treatment.

Follow-up care

If you are referred to Oxford from another hospital, we are able to share your follow-up care with your local hospital. This allows you to continue to receive specialist care closer to home.

Clinics

HPB Clinic

Friday mornings, starting at 9.00am
Outpatients' Clinic, Cancer Centre, Churchill Hospital

The usual waiting time to be seen at the clinic, from time of referral, is on average within 14 days. This can be longer at times, if we are waiting for scan results to guide treatment plans.

After we review the scans and other investigations, we tailor a treatment plan to each patient. Patients are seen (usually by a consultant surgeon or a senior member of the surgical team) the same morning, in the Outpatients' Clinic.

There are four consultation surgeons within the hepatobiliary team in Oxford, who all work very closely together. You may meet more than one consultant depending on when your surgery is scheduled.

In the clinic we will discuss the diagnosis, stage of disease and treatment options with the patient. At first clinic visit you will also meet a member of the Clinical Nurse Specialist team. A management plan is agreed.

If surgery is offered, the procedure is explained in detail in order to ensure an informed consent to treatment. We may also discuss participation in clinical trials and research if this would be of interest or relavant to your treatment.

Pre-operation Assessment Clinic

Before having an operation, patients are required to attend a Pre-operation Assessment Clinic.

This is usually within one to two weeks of the date of surgery. This clinic is usually at the Churchill hospital, but on occasion may be at the John Radcliffe Hospital.

At this clinic, general health and fitness for anaesthesia and surgery is assessed. Patients may be asked questions about their general health and any other additional health concerns, and may be required to see an anaesthetist. Some patients will be asked to have CPET (cardio pulmonary exercise testing - checking for heart and lung function reserve using an indoor exercise bike) or to have special tests for heart function and lung function assessment.

Admission to hospital for surgery

Unless otherwise indicated, patients will be asked to arrive at the Theatre Direct Admissions (TDA) Ward on the morning of the operation.

Theatre Direct Admissions
Level 2, Cancer Centre, Churchill Hospital

On the day of your surgery, you will meet the surgeon and the anaesthetic team again before going into theatre.

Immediately after surgery patients are admitted to the Churchill Overnight Recovery Unit (CORU) for monitoring, unless Churchill Intensive Care Unit (CICU) is required.

Following an overnight stay on CORU, you would normally be transferred to the Oxford Upper Gastrointestinal (UGI) Centre.

Going home

In most cases patients remain in hospital for six to 12 days after their operation, and will need painkillers for a few weeks. Full recovery can take up to three months.

If you have concerns about going home (for example, if you live alone, or have several flights of stairs to climb), please let the nursing staff or doctor know when you are admitted to the ward, so that help can be arranged.

The nurse specialist is available to help support patients and families, and social workers are often available to give practical advice regarding financial concerns. Maggie's Oxford on the Churchill Hospital site provides additional support.

It is usual that two to three weeks following discharge from hospital we will give you an appointment to attend an Outpatient Clinic for a postoperative check-up. This is a good time to discuss any problems. If you have any problems or worries before the appointment, please ring your nurse specialist for advice, or the ward if out of hours.

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