Brain and CNS 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope


REFERRAL GUIDELINES FOR SUSPECTED BRAIN AND CNS CANCER (All patients will be seen within 2 weeks of referral)

  • Consider an urgent direct access MRI scan of the brain (or CT scan if MRI is contraindicated) to assess for brain or central nervous system cancer in adults with progressive, sub-acute loss of central neurological function. You may consider using e-consultation with the Radiology Department to discuss the most appropriate imaging.
  • Refer a patient who presents with symptoms suggestive of brain or CNS cancer as detailed in the NICE guidance below:
  • Discuss any concerns about a patient's symptoms and/or signs with a local specialist. If rapid access to scanning is available, consider as an alternative to referral.
  • Re-assessment and re-examination is required if the patient does not progress according to expectations.
  • Only refer when patient is available to attend an appointment within the next 14 days.

Assessment

  • In a patient with new, unexplained headaches or neurological symptoms, undertake a neurological examination guided by the symptoms, but including examination for papilloedema. Note that the absence of papilloedema does not exclude the possibility of brain tumour
  • When a patient presents with seizure, take a detailed history from the patient and an eyewitness to the event. Carry out a physical examination, including cardiac, neurological and mental state, and developmental assessment, where appropriate.

Please refer to NICE referral guidelines for suspected cancer

Red Flags

Referral

Referral Criteria

Urgent 2ww:

  • Refer urgently patients with:
  • Symptoms related to the CNS, including:
    • progressive neurological deficit
    • new-onset seizures
    • headaches
    • mental changes
    • cranial nerve palsy
    • unilateral sensorineural deafness
  • in whom a brain tumour is suspected.
  • Headaches of recent onset accompanied by features suggestive of raised intracranial pressure, for example:
    • Vomiting
    • drowsiness
    • posture-related headache
    • pulse-synchronous tinnitus
  • or by other focal or non-focal neurological symptoms, for example blackouts, change in personality or memory.
  • A new, qualitatively different, unexplained headache that becomes progressively severe
  • Suspected recent-onset seizures (refer to neurologist)

Consider urgent referral in patients with rapid progression of:

  • Subacute focal neurological deficit
  • Unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these
  • Personality changes confirmed by a witness and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour

Non-Urgent Referral:

  • Consider non-urgent referral or discussion with specialist for:
    • Unexplained headaches of recent onset:
    • present for at least 1 month
    • not accompanied by features suggestive of raised intracranial pressure

Risk Factors:

  • Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:
    • Recent-onset seizure
    • Progressive neurological deficit
    • Persistent headaches
    • New mental or cognitive changes
    • New neurological signs

Referral Instructions:


Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA2 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
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