Signs and symptoms to investigate

The following signs and symptoms should be investigated:

• abdominal pain
• bloating
• repeated dry flushing on the face and neck
• diarrhoea, even while not eating
• wheezing/bronchoconstriction (asthma-like symptoms)
• episodes of hypotension or palpitations
• unexplained right-sided heart disease
• unexplained weight loss
• fatigue.

Refer to the optimal care pathway for people with NETs for more specific symptoms for the NET location.

Initial investigations include:

• taking of a medical history and a physical examination
• full blood count, B12 and serum iron, LFTs and renal function, thyroid, calcium, cholesterol and CRP
• imaging tests (e.g. ultrasound, CXR, CT scans)
• referral for endoscopy/colonoscopy or bronchoscopy depending on imaging result.
• Refer to the optimal care pathway for people with NETs for specific investigations of the NET location.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

• explaining to the patient and/or carer who they are being referred to and why
• supporting the patient and/or carer while waiting for specialist appointments
• informing the patient and/or carer that they can contact: Cancer Council on 13 11 20
• NET Nurse at NeuroEndocrine Cancer Australia on 1300 287 383.

Checklist

• Signs and symptoms recorded
• Investigation as per suspected site of NET
• Supportive care needs assessment completed and recorded, and referrals to allied health services actioned as required
• Patient notified of support services (e.g. Cancer Council and NeuroEndocrine Cancer Australia)
• Referral options discussed with the patient and/or carer including cost implications.

Timeframe

Where this is a strong suspicion of NETs, investigations should be conducted within 2 weeks of the initial GP appointment.
All patients with a suspected or proven NET should be referred to an appropriate specialist within 1 week of completing initial investigations.