Head and Neck 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 HEAD & NECK CANCER INCLUDING THYROID CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of head and neck cancer including thyroid cancer as detailed in the NICE guidance below.
  • Only refer when patient is available to attend an appointment within the next 14 days.

Assessment

With the exception of persistent hoarseness, investigations are not recommended as they can delay referral.

Thyroid Cancer Investigations

  • Primary care initiation of investigations such as ultrasonography or isotope scanning is not recommended.
  • Request thyroid function tests in patients with a thyroid swelling without stridor or any of the features listed below.
  • Refer patients with hyper or hypothyroidism and an associated goitre, non-urgently, to an endocrinologist.
  • Patients with goitre and normal thyroid function tests without any of the features listed above should be referred non-urgently

Please refer to NICE referral guidelines for suspected cancer

Referral

Referral Criteria

Urgent 2ww:

  • An unexplained lump in the neck, of recent onset, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
  • An unexplained persistent swelling in the parotid or submandibular gland
  • An unexplained persistent sore or painful throat
  • Unilateral unexplained pain in the head and neck area for more than 4 weeks, associated with otalgia (ear ache) but a normal otoscopy
  • Unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks
  • Unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful or swollen or bleeding
  • For patients with persistent symptoms or signs related to the oral cavity in whom a definitive diagnosis of a benign lesion cannot be made
    • refer or follow up until the symptoms and signs disappear.
    • If the symptoms and signs have not disappeared after 6 weeks, make an urgent referral.

If no Community Dental service is available:

  • consider an urgent for assessment for possible oral cancer by a dentist in people who have either:
    • A lump on the lip or in the oral cavity or
    • A red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

Refer to Maxillo-facial/Head and neck service if the patient has:

  • A lump on the lip or in the oral cavity consistent with oral cancer or
  • A red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
  • An unexplained thyroid lump ? suspicion of cancer from scan – i.e., scan needs to be done before referral made.

Refer urgently to dental practitioner patients with:

  • unexplained tooth mobility persisting for more than 3 weeks.

Refer urgently for Chest X-Ray patients with:

  • hoarseness persisting for more than 3 weeks, particularly smokers aged over 50 years and heavy drinkers.
  • If there is a positive finding, refer urgently to a team specialising in the management of lung cancer. If there is a negative finding, refer urgently to a team specialising in head and neck cancer.

Refer non-urgently

  • a patient with unexplained red and white patches of the oral mucosa that are not painful, swollen or bleeding (including suspected lichen planus).

THYROID CANCER

  • Refer immediately as an emergency patients with symptoms of tracheal compression including stridor due to thyroid swelling.
  • Refer urgently patients with a thyroid swelling associated with any of the following:
    • a solitary nodule increasing in size
    • a history of neck irradiation
    • a family history of endocrine tumour
    • unexplained hoarseness or voice changes
    • cervical lymphadenopathy
    • very young (pre-pubertal) patient
    • patient aged 65 years and older

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: 02.2020
  • Ref No: CA6 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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