Information
Carcinomatosis lymphangitis is infiltration and obstruction of the pulmonary lymphatic system. It can occur with all malignancies but is most common with adenocarcinomas particularly breast, lung, colon and stomach.
Most common symptoms are breathlessness, cough and haemoptysis.
Unfortunately prognosis is poor with less than 50% of patients surviving more than 3 months. Treatment is symptomatic with corticosteroids and often palliative care input. Discussion with oncology is recommended if lymphangitis is suspected.
Who to refer:
Patients with a cancer diagnosis and symptoms suggestive of lymphangitis.
Who not to refer:
If in doubt please do not hesitate to call. Depending on the patient’s prognosis and wishes a trial of steroids in the community may be recommended.
How to refer:
Contact the Acute Oncology team at the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
If the patient is clearly approaching end of life and hospital admission is best avoided, dexamethasone 4mg BD with PPI cover (given before 2pm to avoid insomnia) and 2.5 mgs of oromorph QDS could be tried for symptomatic benefit. If unsure please call to discuss.
All patients on or within 6 weeks of treatment should be encouraged to monitor symptoms and call Cancer Treatment Helpline (CTH) on 08009177711 if any treatment related concerns. Please note the CTH is a call operator service provided by NHS 24 who then refer on to acute care specialist. They are not able to give specialist advice. Note if a patient has presented to primary care for assessment the patient should not be advised to call the CTH to pass on this information or seek further advice. The primary care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre to discuss if appropriate.
Link to Acute Oncology Initial Management Guidelines:
UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
