NICE 2ww referral criteria

Question 1

2ww for lung cancer if:

Answer 1

CXR suggests lung cancer
>40y + unexplained haemoptysis

Question 2

Offer 2-week CXR to >40y with 2+ of:
(unexplained)

Answer 2

Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss

Question 3

Offer 2-week CXR to ever-smokers with 1+ of:
(unexplained)

Answer 3

Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss

Question 4

Consider 2-week CXR if >40y with:

Answer 4

Persistent/recurrent LRTI
Clubbing
Supraclavicular LN
Persistent cervical LN
Suspicious chest signs
Thrombocytosis

Question 5

2ww for mesothelioma if:

Answer 5

CXR suggests mesothelioma

Question 6

Offer 2-week CXR to >40y with asbestos exposure + 1+ unexplained:

Answer 6

Cough
Fatigue
Shortness of breath
Chest pain
Weight loss
Appetite loss

Question 7

Consider 2-week CXR to >40y with

Answer 7

Clubbing
Chest signs of pleural disease

Question 8

Dysphagia

Answer 8

Offer 2-week direct-access OGD

Question 9

Offer urgent direct-access OGD to >55y with weight loss and:

Answer 9

• Upper abdo pain
• Reflux
• Dyspepsia

Question 10

Haematemesis

Answer 10

Consider non-urgent direct-access OGD

Question 11

> 55 + treatment-resistant dyspepsia

Answer 11

Consider non-urgent direct-access OGD

Question 12

> 55 + upper abdo pain + low Hb

Answer 12

Consider non-urgent direct-access OGD

Question 13

Consider non-urgent OGD in >55y with raised platelets and

Answer 13

• nausea
• vomiting
• weight loss
• reflux
• dyspepsia
• upper abdo pain

Question 14

Consider non-urgent OGD in >55y with nausea/vomiting and

Answer 14

• weight loss
• reflux
• dyspepsia
• upper abdo pain

Question 15

2ww referral for pancreatic cancer if:

Answer 15

> =40y + jaundice

Question 16

Consider urgent direct-access CT (pancreas) if >=60 with weight loss and:

Answer 16

Diarrhoea
Back pain
Abdo pain
Nausea/vomiting
Constipation
New-onset diabetes

Question 17

Upper abdo mass

Answer 17

Consider 2ww Referral

(gastric)

Question 18

Upper abdo mass consistent with enlarged gall bladder

Answer 18

Consider 2-week direct-access US

Question 19

Upper abdo mass consistent with enlarged liver

Answer 19

Consider 2-week direct-access US

(liver)

Question 20

> 40y + unexplained weight loss + abdo pain

Answer 20

2ww Referral

(colorectal)

Question 21

> 50y + unexplained rectal bleeding

Answer 21

2ww Referral (colorectal)

Question 22

> 60y + iron-deficiency anaemia

Answer 22

2ww Referral

(colorectal)

Question 23

> 60y + change in bowel habit

Answer 23

2ww Referral

(colorectal)

Question 24

Tests show occult blood in faeces

Answer 24

2ww referral - colorectal

Question 25

Rectal or abdominal mass

Answer 25

Consider referral via 2ww suspected cancer pathway (colorectal)

Question 26

Consider 2ww referral if <50y + rectal bleeding +

Answer 26

Abdo pain
Change in bowel habit
Weight loss
IDA

Question 27

Offer FIT to >50y (with no rectal bleeding) if have:

Answer 27

Unexplained abdo pain
Unexplained weight loss

Question 28

<60 without rectal bleeding.
Offer FIT if:

Answer 28

Change in bowel habit

IDA

Question 29

> 60 + non-iron-deficient anaemia

Answer 29

Offer FIT

Question 30

Unexplained anal mass/ulceration

Answer 30

Consider referral via 2ww suspected cancer pathway (anal)

Question 31

2ww referral for breast cancer if >30y with

Answer 31

Unexplained breast lump with/without pain

Question 32

2ww referral for breast cancer if >50y with

Answer 32

Unilateral nipple discharge

Unilateral nipple retraction

Other changes of concern

Question 33

Skin changes suggest breast cancer

Answer 33

Consider 2ww referral

Question 34

> 30y + unexplained axillary lump

Answer 34

Consider 2ww referral

(breast)

Question 35

<30y + unexplained breast lump (with/without pain)

Answer 35

Consider non-urgent referral for breast cancer