2 week wait

Question 1

Lung cancer:
1) 2ww criteria?
2) Urgent CXR criteria? (‘refer’ plus ‘consider’) Timeline of this?

Answer 1

1) CXR findings consistent with cancer or >40y and unexplained haemoptysis

2) CXR within 2 weeks: >40 + 2 of or previous/current smoker/asbestos exposure + 1 of: cough, fatigue, weight loss, SOB, chest pain, appetite loss.

‘Consider’ : >40 + thrombocytosis, persistent cervical lymphadenopathy, finger clubbing, recurrent or persistent chest infections, chest abnormality on auscultation,

Question 2

Oesophageal cancer
1) 2ww criteria?
2) Non urgent OGD referral?

Answer 2

1) Dysphagia or Weight loss plus one of: upper abdominal pain, reflux, dyspepsia.
2) >55y plus:
- treatment resistant dyspepsia
- upper abdo pain and anaemia
- N&V + weight loss, dyspepsia, reflux
- Thrombocytosis + N&V/ dyspepsia/ reflux/ weight loss

Question 3

Pancreatic cancer:
1) 2ww criteria?
2) Urgent CT/USS criteria (within 2 weeks)?

Answer 3

1) >40y + unexplained jaundice
2) >60y + weight loss + one of: nausea, back pain, abdominal pain, new or worsening diabetes, constipation, vomiting.

Question 4

Stomach cancer:
1) 2ww criteria?
2) Non urgent OGD criteria?

Answer 4

1) Upper abdominal mass consistent with cancer.
2) Haematemesis
>55y plus:
- treatment resistant dyspepsia
- upper abdo pain and low Hb
- thrombocytosis and weight loss/ N&V/ upper abdo pain/ dyspepsia
- N&V and weight loss, dyspepsia, reflux

Question 5

Colorectal cancer:
1) 2ww criteria?
2) Consider 2ww
3) Offer FIT?

Answer 5

1) >40y + unexplained wt loss & abdominal pain or
>50y + unexplained PR bleeding or
>60y + IDA or change in bowel habit or positive FIT or
Rectal mass/ unexplained ulceration
2) Consider: <50 y + unexplained rectal bleeding AND abdo pain/ CIBH/ wt loss/ IDA
3) FIT: >50 + abdo pain or weight loss
>60 + CIBH or IDA

Question 6

Breast cancer:
1) 2ww criteria?
2) ‘Consider 2ww’ criteria
3) Non urgent referral

Answer 6

1) >30y plus unexplained breast lump or >50y plus unilateral nipple discharge or retraction.
2) Breast skin changes, >30y + axillary lump
3) <30y and breast lump

Question 7

Ovarian cancer:
1) 2ww criteria?
2) Who should we investigate in primary care?
3) What are the investigations of choice?

Answer 7

1) Ascites or pelvic/abdominal mass found on clinical examination
2) Unexplained weight loss, persistent bloating, early sateity/loss of appetite, urinary urgency/ frequency, pelvic pain, fatigue, change in bowel habit. >50y plus new IBS symptoms
3) Ca 125 first, if >35 TVUS- if both normal, reassure but return if symptoms worsen.

Question 8

Endometrial cancer:
1) 2ww criteria
2) Consider urgent TVUS in GP

Answer 8

1) >55y & PMB or consider <55y + PMB (ie bleeding after 1 year amenorrhoea
2) >55y & unexplained PV discharge + first presentation/ high blood sugars/ high platelets or associated haematuria. Or visible haematuria + anaemia or thrombocytosis.

Question 9

Prostate cancer:
1) 2ww criteria
2) Who to PSA/DRE?

Answer 9

1) Abnormal feeling prostate on examination. PSA above age cutoff (consider in these patients)
2) Any LUTS, erectile dysfunction, visible haematuria.

Question 10

Bladder cancer:
1) 2ww criteria?
2) Non urgent criteria?

Answer 10

1) >45y + visible haematuria in absence of UTI or persistent visible haematuria after successful treatment of UTI.
>60y + non visible haematuria + either raised WCC or dysuria
2) >45y with recurrent or persistent unexplained UTI.