Guidelines

Question 1

2ww ENT criteria

Answer 1

Chronic (u/l) rhinosinusitis 
Globes pharyngeus (lump) 
Hoarseness >3w 
Dizziness 
Hearing loss 
Snoring/sleep apnea 
Otitis external 
Chronic catarrh

Question 2

Lung cancer: urgent referral criteria

Answer 2

CXR suggestive of cancer

>40 with unexplained haemoptysis

Question 3

Urgent CXR referral

Answer 3

>40 yrs + 2 unexplained symptoms (1 if smoking history) 
- cough 
- fatigue 
- SOB 
- chest pain 
- weight loss
- appetite loss 
Consider in persistent chest infections, clubbing, supraclavicular or clerical lymph nodes, thrombocytosis

Question 4

Urgent endoscopy referral

Answer 4

Dysphagia 
Over 55 with:
- upper abdo pain 
- reflux 
- dyspepsia

Question 5

Urgent CT criteria

Answer 5

Pancreatic cancer 
>40 yrs with jaundice  
>60 yrs with weight loss and 1 of: 
- diarrhoea 
- back pain 
- abdo pain 
- vomiting 
- nausea 
- constipation 
- new onset diabetes

Question 6

Urgent upper GI appointment

Answer 6

Abdominal mass

Consistent with cancer

Question 7

Urgent GB or liver USS scan criteria

Answer 7

GB or upper GI mass

Consistent with cancer

Question 8

Urgent colorectal cancer referral (3 ages)

Answer 8

40 and over with unexplained weight loss and abdo pain or
50 and over with unexplained rectal bleeding or
60 and over with:
-iron‑deficiency anaemia or
-changes in their bowel habit, or
-blood in faeces (Ix)
OR abdo mass consistent with cancer

Question 9

Breast cancer referral cancer criteria

Answer 9

aged 30+ with unexplained breast lump +/- pain or
aged 50+ with any of the following symptoms in one nipple
- discharge
- retraction
-other changes of concern

Consider in:

• skin changes that suggest breast cancer or
• aged 30 and over with an unexplained lump in the axilla

Question 10

Gynaecological cancer referral criteria (18+)

Answer 10

Ascites and/pelvic mass

Abnormal investigations

Question 11

Suspected ovarian cancer in primary care: investigation

Answer 11

CA125

>35 -> USS -> referral if suggestive of cancer

Question 12

Endometrial cancer referral criteria

Answer 12

Over 55 with pv bleeding 1 year post-menopause

Question 13

Bladder or renalcancer referral criteria

Answer 13

Over 45 with visible haematuria (post UTI treatment or w/o UTI)
Over 60 with unexplained invisible harmaturia and
- dysuria
- WCC

Question 14

Malignant melanoma referral criteria

Answer 14

3+ points
Change is size, shape, colour (2 pts each) 
Inflammation (1)
Oozing  (1)
Change is sensation  (1)
>7mm  (1)

Question 15

Head and neck referral criteria

Answer 15

Persistent hoarseness

Unexplained lump on neck/oral cavity/lip/thyroid

Question 16

Suspected myeloma (persistent bone pain, back pain, unexplained fracture) investigations

Answer 16

FBC, Ca, plasma viscosity, ESR in 60+ yrs

• > hypercalcaemia, leukopenia
• > protein electrophoresis and urine Bence-Jones
• > urgent referral