North East London and South Essex MSCC Pathway

If there is suspicion of MSCC: Contact the MSCC co-ordinator immediately using the contact details below.

Immediate Management Steps

Immediately contact the MSCC coordinator
Treat this as an oncological emergency
Start immobilisation without delay if symptoms or signs suggest spinal instability
Consider immobilisation if moderate to severe pain is associated with movement
Offer 16 mg of oral dexamethasone (or equivalent parenteral dose) as soon as possible. After the initial dose, continue 16 mg daily while awaiting surgery or radiotherapy
Carry out a pain assessment and agree a pain management plan
Ensure adequate pain relief, including non-opioid or opioid analgesic medication, individually or in combination
Consider giving corticosteroids for people without neurological symptoms or signs if they have:
- Severe pain, or
- A haematological malignancy
Carry out MRI as soon as possible (always within 24 hours) at the local hospital or appropriate centre with direct access imaging facilities if MSCC is suspected
If MRI is contraindicated, carry out a CT scan

Barts Health: Call 07957 724 979 in working hours or OOH call 0207 3777000 and ask for on-call Oncology Registrar
Barking, Havering & Redbridge: Call 01708 435 000 ext: 6408 (9-5 pm). OOH: bleep neuro-surgical registrar on 6177
Princess Alexandra: Contact AOS (bleep 141) or OOH: contact NMUH on-call oncology 0208 887 200
Southend (MSE Trust): MSCC Coordinator Oncology SpR bleep: 4001 (9.00 – 21:00). OOH: via switch ask for on-call reg for oncology

If patient has a known oncologist, inform them of patient's symptoms