2 week wait referral criteria Flashcards
Refer people using a suspected cancer pathway referral for lung cancer if they have…
- chest X-ray findings which suggest lung cancer
OR - aged 40+ with haemoptysis
Offer urgent CXR (within 2 weeks) to assess for lung cancer in _____ if they have ________
Offer an urgent chest X-ray (to be done within 2 weeks) to assess for lung cancer
in people aged 40 and over if they have 2 or more of the following unexplained
symptoms, or if they have ever smoked and have 1 or more of the following
unexplained symptoms:
- cough
- shortness of breath
- chest pain
- fatigue
- weight loss
- appetite loss
Consider an urgent chest X-ray (within 2 weeks) for lung cancer ______
Consider an urgent chest X-ray (to be done within 2 weeks) to assess for lung
cancer in people aged 40 and over with any of the following:
- persistent or recurrent chest infection
- finger clubbing
- supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
- chest signs consistent with lung cancer
- thrombocytosis
Refer people using a suspected cancer pathway referral for mesothelioma if they have…
chest X-ray findings that suggest mesothelioma
Offer an urgent CXR to assess for mesothelioma in people ____
Aged 40 and over if:
2 or more of the following unexplained symptoms
1 or more of the following unexplained symptoms + have ever smoked
1 or more of the following unexplained symptoms + have been exposed to asbestos
- fatigue
- weight loss
- appetite loss
- chest pain
- shortness of breath
- cough
Consider an urgent CXR to assess for mesothelioma in people aged 40+ with:
finger clubbing or chest signs compatible with pleural disease
Offer urgent direct access upper GI endoscopy (within 2 weeks) to assess for oesophageal cancer in people:
- with dysphagia
OR
- aged 55+ with weight loss and any of the following:
- upper abdominal pain
- reflux
- dyspepsia
Consider non-urgent direct access upper GI endoscopy to assess for oesophageal cancer in people with:
haematemesis
people aged 55+ with:
- treatment resistant dyspepsia
OR - upper abdominal pain with low haemoglobin levels
OR - raised platelet count with any of the following:
nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
OR
- nausea and vomiting with any of the following:
weight loss, reflux, dyspepsia, upper abdominal pain
Refer people using a suspected cancer pathway referral for pancreatic cancer if:
aged 40+ with jaundice
Consider urgent direct access CT or an urgent ultrasound scan if CT not available to assess for pancreatic cancer in:
people aged 60 with weight loss and any of the following:
- diarrhoea
- constipation
- back pain
- abdominal pain
- nausea
- vomiting
- new onset diabetes
Offer urgent direct access upper GI endoscopy to assess for stomach cancer in people:
with dysphagia
OR
aged 55+ with weight loss and any of the following:
- upper abdominal pain
- reflux
- dyspepsia
Consider non-urgent, direct access upper GI endoscopy to assess for stomach cancer in:
people aged 55+ with:
- treatment resistant dyspepsia
OR
- upper abdominal pain with low Hb levels
OR
- raised platelet count with any of the following:
nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
OR
nausea and vomiting with any of the following:
- weight loss
- reflux
- dyspepsia
- upper abdominal pain
Consider an urgent direct access ultrasound scan to assess for gallbladder cancer in people with…
an upper abdominal mass consistent with an enlarged gall bladder
Consider an urgent direct access ultrasound to assess for liver cancer in people…
with an upper abdominal mass consistent with an enlarged liver
Offer FIT testing for suspected colorectal cancer in adults:
- with an abdominal mass
OR
- change in bowel habit
OR
- iron deficiency anaemia
OR
- aged 40+ with unexplained weight loss and abdominal pain
OR
- aged under 50 with rectal bleeding and either of the following unexplained symptoms: abdominal pain, weight loss
- aged 50 and over with any of the following unexplained symptoms: rectal bleeding, abdominal pain, weight loss
Should FIT be offered even if person has previously had a negative FIT result through NHS bowel cancer screening programme?
Yes
Which people do not need to be offered FIT before referral is considered?
- rectal mass
- unexplained anal mass
- unexplained anal ulceration
What FIT result would result in suspected colorectal cancer referral?
At least 10mcg of Hb per gram of faeces
Consider a suspected cancer pathway referral for anal cancer in people with…
- unexplained anal mass
- unexplained anal ulceration
Refer for suspected breast cancer pathway if patient is:
- aged 30+ with an unexplained breast lump with or without pain
OR
- aged 50 with any of the following symptoms in one nipple only: discharge, retraction, any other changes of concern
Consider suspected breast cancer referral in people…
- with skin changes that suggest breast cancer
OR
- aged 30+ with an unexplained lump in axilla
Consider non-urgent breast referral in people…
aged under 30 with an unexplained breast lump, with or without pain
Make referral to gynaecological cancer service using suspected cancer pathway referral if…
physical examination identifies ascites and/or pelvic or abdominal mass (which is not obviously uterine fibroids)
Carry out tests in primary care for ovarian cancer if patient reports…
ANY of the following symptoms on a persistent/frequent basis - particularly if aged 50 or over and if more than 12 times per month
- persistent abdominal distension (bloating)
- early satiety/loss of appetite
- pelvic/abdominal pain
- increased urinary urgency/frequency
If patient reports unexplained weight loss, fatigue, changes in bowel habit
Carry out appropriate tests for ovarian cancer in any female patient aged 50+ who has experienced….
symptoms within the last 12 months that suggest IBS, as IBS rarely presents for the first time in women of this age
Measure __ in primary care in patients with symptoms that suggest ovarian cancer
Ca125
What to do with results of Ca125?
If > 35IU/ml - arrange ultrasound of abdomen and pelvis
If ultrasound suggests ovarian cancer, make a referral to gynaecological cancer service using a suspected cancer pathway referral
If Ca125 normal or high but normal ultrasound?
- assess for other clinical causes of sx
- advise to return to GP is sx become more frequent or persistent
Refer using a suspected endometrial cancer pathway referral if patient is:
Aged 55 and over with post-menopausal bleeding (more than 12 months after menstruation has stopped)
Consider suspected cancer pathway referral in…
Women under 55 with PMB
Consider direct access ultrasound to assess for endometrial cancer in:
women aged 55+ with:
- unexplained symptoms of vaginal discharge who:
are presenting for the first time OR have thrombocytosis OR report haematuria
- visible haematuria and:
low Hb levels OR thrombocytosis OR high blood glucose levels
Consider a suspected cancer pathway referral for cervical cancer if…
on examination, the appearance of the cervix is consistent with cervical cancer
Consider a suspected cancer pathway referral for vulval cancer in…
patients with an unexplained vulval lump, ulceration, or bleeding
Consider a suspected cancer pathway referral for vaginal cancer in patients with…
unexplained palpable mass in or at entrance to vagina
Refer people using suspected cancer pathway referral for prostate cancer if…
prostate feels malignant on DRE
Consider PSA and digital rectal examination to assess for prostate cancer in people with:
- any lower urinary tract symptoms e.g. nocturia, urinary frequency, urgency, or retention
OR
- erectile dysfunction
OR
- visible haematuria
Referring for suspected prostate cancer pathway referral after PSA results come back
Below 40 - use clinical judgement
40-49: > 2.5
50-59: > 3.5
60-69: > 4.5
70-79: > 6.5
>79: use clinical judgement
Refer for suspected cancer pathway referral for bladder cancer if:
aged 45 and over and have:
- unexplained visible haematuria without UTI
OR
- visible haematuria that persists or recurs after successful treatment of urinary tract infection
aged 60 and over and have:
- unexplained non-visible haematuria
- dysuria OR raised white cell count on a blood test
Consider non-urgent referral for bladder cancer in…
people aged 60+ with recurrent or persistent unexplained UTI
Refer people using suspected cancer pathway referral for renal cancer if:
they are aged 45+ and have:
- unexplained visible haematuria without UTI
OR
- visible haematuria that persists or recurs after successful treatment of UTI
Consider a suspected cancer pathway referral for testicular cancer in men if…
they have a non-painful enlargement or change in shape/texture of the testis
Consider a direct access ultrasound scan for testicular in men with…
unexplained or persistent testicular symptoms
Consider a suspected cancer pathway referral for penile cancer in men if they have…
- a penile mass or ulcerated lesion, when an STI has been excluded as a cause
- a peristent penile lesion after treatment for a STI has been completed
- unexplained or persistent symptoms affecting the foreskin or glans
Refer people using suspected cancer pathway referral for melanoma if they have…
suspicious pigmented skin lesion with a weighted 7 point checklist score of 3 or more
Major features (2 points each)
- change in size
- irregular colour
- irregular shape
Minor features (1 point each)
- largest diameter 7mm or more
- itching
- oozing
- change in sensation
OR
if dermoscopy suggests melanoma of the skin
Consider a suspected cancer pathway referral for melanoma in people with:
- a pigmented/non-pigmented skin lesion that suggests nodular melanoma
Typical features of a basal cell carcinoma?
- ulcer with a raised rolled edge
- prominent fine blood vessels around a lesion
- a nodule on the skin (particularly pearly or waxy)
Consider a suspected cancer pathway referral for laryngeal cancer in…
people aged 45+ with:
- persistent unexplained hoarseness
- unexplained lump in neck
Consider a suspected cancer pathway referral for oral cancer in people with…
- unexplained ulceration in oral cavity lasting more than 3 weeks
OR
- persistent and unexplained lump in the neck
Consider an urgent referral for assessment for possible oral cancer by a dentist in people with…
- lump on the lip or in the oral cavity
OR
- red or red & white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
Consider a suspected cancer pathway referral by the dentist for oral cancer in people when assessed by a dentist as having…
- a lump on the lip or in the oral cavity consistent with oral cancer
- a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
Consider a suspected cancer pathway referral for thyroid cancer in people with…
an unexplained thryoid lump
Consider an urgent direct access MRI scan of the brain (or CT if MRI contraindicated) to assess for brain or CNS cancer in adults with…
progressive, subacute loss of central neurological function
Newly abnormal cerebellar or other central neurological function in children & young people?
Very urgent (within 48 hours) referral for suspected brain or CNS cancer
Leukaemia in adults
consider a very urgent FBC (within 48 hours) to assess for leukaemia in adults with any of the following:
- pallor
- persistent fatigue
- unexplained fever
- unexplained persistent or recurrent infection
- generalised lymphadenopathy
- unexplained bruising
- unexplained petechiae
- hepatosplenomegaly
Leukaemia in children and young people
immediate specialist assessment if unexplained petechiae or hepatosplenomegaly
offer a very urgent (within 48 hour) FBC to assess for leukaemia in children and young people with any of the following:
- pallor
- persistent fatigue
- unexplained fever
- unexplained persistent infection
- generalised lymphadenopathy
- persistent or unexplained bone pain
- unexplained bruising
- unexplained bleeding
myeloma referral
offer FBC and blood tests for calcium and plasma viscosity or ESR to assess for myeloma in people aged 60+ with:
- persistent bone pain (especially back)
OR - unexplained fracture
offer very urgent electrophoresis and Bence-Jones protein urine test (within 48 hours) to assess for myeloma in people aged 60+ with:
- hypercalcaemia
OR - leukopenia
AND presentation consistent with possible myeloma
consider very urgent electrophoresis and Bence-Jones protein urine test (within 48 hours) if plasma viscosity or ESR and presentation are consistent with possible myeloma
THEN
Refer for suspected cancer pathway referral if results of protein electrophoresis or Bence-Jones protein urine test suggest myeloma
Non-Hodgkin’s & Hodgkin’s lymphoma: adults
consider a suspected cancer pathway referral for non-Hodgkin’s lymphoma in adults presenting with:
- unexplained lymphadenopathy OR splenomegaly
when referring, take into account any associated Sx:
- fever
- night sweats
- weight loss
- SOB
- pruritus
Non-Hodgkin’s & Hodgkin’s lymphoma: children
consider a very urgent (within 48 hours) referral for non-Hodgkin’s lymphoma in children & young people presenting with:
- unexplained lymphadenopathy OR splenomegaly
when referring, take into account any associated Sx:
- fever
- night sweats
- weight loss
- SOB
- pruritus
Bone sarcoma: adults
Consider a suspected cancer pathway referral for adults if X-ray suggests possibility of bone sarcoma
Bone sarcoma: children
Consider very urgent direct access X-ray (to be done within 48 hours) to assess for bone sarcoma in children & young people with unexplained bone swelling or pain
Consider a very urgent (within 48 hours) referral for specialist assessment if X-ray suggest possibility of bone sarcoma
Soft tissue sarcoma: adults
consider an urgent, direct access ultrasound scan to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size
Consider suspected cancer pathway referral for adults if they have ultrasound scan findings that are suggestive of soft tissue sarcoma/ if ultrasound findings are uncertain and clinical concern persists
Soft tissue sarcoma in children and young people
Consider a very urgent direct access ultrasound scan (to be done within 48 hours) to assess for soft tissue sarcoma in children and young people with an unexplained lump that is increasing in size
Consider very urgent referral for children & young adults if they have ultrasound scan findings that are suggestive of soft tissue sarcoma/ if ultrasound findings are uncertain and clinical concern persists
Neuroblastoma
Consider very urgent referral (within 48 hours) for specialist assessment for neuroblastoma in children with a palpable abdominal mass or unexplained enlarged abdominal organ
Retinoblastoma
Consider referral for ophthalmological assessment using a suspected cancer pathway referral for retinoblastoma in children with absent fundal (‘red’) reflex
Wilms’ tumour
Consider very urgent referral (within 48 hours) for specialist assessment for Wilm’s tumour in children with any of the following:
- palpable abdominal mass
- unexplained enlarged abdominal organ
- unexplained visible haematuria
