High dose oral steroids 12mg dexamethasone given as a single dose as soon as the diagnosis is suspected and continued until the diagnosis is confirmed and subsequent treatment is in place. If the patient is at risk of GI side effects, start appropriate GI protection at the same time in the form of a proton pump inhibitor.
Contact local clinical oncologist the same day to discuss the need for hospital admission, investigation and palliative radiotherapy. Occasionally neuro-surgical intervention is required. The aim is to maintain function
Institute adequate pain relief measures.
Catheterise if there appears to be sphincter involvement.
