MSCC recognition signs and symptoms

Macmillan have some excellent information that is aimed at patients, it is also a really helpful aide memoir for professionals

The RED FLAG alert card for health professionals

METASTATIC SPINAL CORD COMPRESSION – RED FLAGS

• The RED FLAG card is a credit card sized reminder that can be distributed amongst all staff who potentially may come into contact with this patient group.  The RED FLAG acronym has been used to alert the clinician to a series of symptoms which can indicate serious spinal pathology.

• The red flag cards build on work by the Manchester Cancer MSCC Coordinator Service who have also developed a comprehensive website including a pathway, guidelines and protocols for the management of MSCC  (www.christie.nhs.uk/mscc)

• It is to be encouraged that the cards be distributed amongst relevant clinical staff in your organisation to help raise awareness of the condition, the consequences and the network wide care pathway to ensure responsive treatment.

• If you would like to use these cards in your own organisations, we would be happy to send you the art work.  You can remove the Christie logo and replace it with your own on the understanding that the authors name remain and the text is not changed and that the Christie are acknowledged as the producers.  

• For more information please contact the MSCC service on mscc.service@nhs.net or by telephone via the Christie switchboard.  

• The Manchester Cancer Network Group for Metastatic Spinal Cord Compression (MSCC) was asked to produce an easy to use resource which would aid in prompting the early diagnosis of MSCC through a red flag card describing the key symptoms of this condition.  

• In 2010, the group worked with experts and considered the essential minimum data requirements to raise the index of suspicion suggestive of MSCC.  The main target audience for this information were non-specialist clinicians in a primary care setting but it was recognised that a much broader audience would also benefit from the information in order to raise awareness and for education purposes.     

• The MSCC care pathway has ensured speedy referral and treatment for those people with suspicious spinal pathology.  Key to that process is early diagnosis, but with 25% of patients who develop MSCC having no previous diagnosis of cancer, helping clinicians identify serious spinal pathology is of paramount importance. 

• This 25% prove particularly challenging to identify in Primary Care.  Instigation of appropriate treatment plans should be immediate in this condition and unacceptable delays avoided.  The consequences in delaying treatment of MSCC include paraplegia or quadriplegia, loss of control of bladder and bowel function with associated loss of quality of life. 

The information is based on the following evidence:

Levack P, et al.  Don’t wait for the sensory level- listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression.  Clinical Oncology 2001;14:472-480

Greenhalgh S, Selfe J, (2009) Red flags II: A Clinical Guide to Solving Serious Spinal Pathology.  Elsevier

National Institute for Health and Care Excellence (2008) Metastatic Spinal Cord Compression: Diagnosis and management of patients at risk of or with metastatic spinal cord compression. Cardiff: National Collaborating Centre for Cancer, cg75. (Online). Available: http://publications.nice.org.uk/metastatic-spinal-cord-compression-cg75 (16/9/13).