2WW Referral Criteria

Question 1

Lung

Answer 1

> 40 years with unexplained haemoprysis, CXR suggestive of cancer

Urgent CXR if > 40 and:
Persistent recurrent chest infection
Finger clubbing
Supraclavicular/cervical lymphadenopathy
Thrombocytosis
2 of: cough, fatigue, SOB, chest pain, weight loss, reduced appetite, smoker, asbestos

Question 2

Upper GI

Answer 2

Urgent endoscopy if
Dysphagia, or >55yrs with weight loss and upper abdominal pain/reflux/dyspepsia

Urgent referral if >40y plus jaundice or upper abdominal mass

Urgent CT of pancreas if >60 years plus weight loss plus any of: diarrhoea, back pain, abdominal pain, nausea, constipation, new-onset diabetes

Question 3

Lower GI

Answer 3

Urgent referral if:
Positive faecal occult blood
>40yrs with abdominal pain plus weight loss
>50yrs with unexplained rectal bleeding
>60yrs with Iron deficiency anaemia or change in bowel habit

Consider urgent referral if:
Rectal/abdominal mass
Anal ulceration
<50yrs with rectal bleeding plus lower GI symptoms or weight loss or IDA

Faecal occult blood testing if > 50 yrs plus abdominal pain or weight loss,
<60yrs with change in bowel habit or IDA
>60yrs with anaemia

Question 4

Gynaecological

Answer 4

Urgent referral if:
Ascites
Pelvic mass (fibroid excluded)
>55yrs with PMB

Question 5

Breast

Answer 5

Urgent referral if:
>30 years with unexplained breast lump
>50 years with symptoms or change to one nipple

Consider urgent referral if skin changes, >30 years with axillary lump

Question 6

Urology

Answer 6

Urgent referral if:
Irregular prostate on PR, abnormal age-specifc PSA
>40yrs with unexplained visible haematuria
>60yrs with unexplained non-visible haematuria plus dysuria or raised WCC
Non-painful enalrgement or change in shape ot texture of testicle

Question 7

MDT for cancer?

Answer 7

Lead clinician
Lead nurse specialist
Radiologists
Histopathologists
Expert surgeons
Oncologist - medical
Palliative care physicians
Patient representative
Administrative support

Coordinates high-quality diagnosis, treatment and care
Should make a recommendations on best initial treatment

Question 8

Laryngeal Cancer

Answer 8

Age 45+
Unexplained persistent hoarse voice
Unexplained lump in neck

Refer for laryngoscopy