NICE 2ww referral criteria - 2

Question 1

2ww for ovarian cancer if:

Answer 1

Finding of ascites or pelvic/abdo mass (not fibroids)
US suggests ovarian cancer

Question 2

Measure CA125 if a woman has persistent/frequent:

Answer 2

Abdo distension/bloating
Early satiety/anorexia
Pelvic or abdo pain
Urinary urgency/frequency
IBS symptoms >50y

Question 3

Consider CA125 test if woman reports:

Answer 3

Unexplained weight loss
Fatigue
Change in bowel habit

Question 4

First-line test for suspected ovarian cancer

Answer 4

Serum CA125

Question 5

Serum CA125 >=35 IU/ml

Answer 5

US abdo-pelvis

Question 6

2ww endometrial cancer referral if:

Answer 6

> 55y + PMB (unexplained, 12m after LMP)

Question 7

Consider 2ww for endometrial cancer if:

Answer 7

<55y + post-menopausal bleeding

Question 8

Consider direct-access US (endometrial) if >55y + unexplained vaginal discharge and:

Answer 8

1st presentation
Thrombocytosis
Report haematuria

Question 9

Consider direct-access US (endometrial) if >55y + visible haematuria and:

Answer 9

Low Hb
Thrombocytosis
High blood glucose

Question 10

Consider 2ww for cervical cancer

Answer 10

Appearance consistent with cervical cancer

Question 11

Consider 2ww for vulval cancer if:

Answer 11

Unexplained vulval lump/ulceration/bleeding

Question 12

Consider 2ww for vaginal cancer if:

Answer 12

Unexplained mass in/at entrance to vagina

Question 13

2ww for prostate cancer if:

Answer 13

Prostate feels malignant on DRE

Question 14

Consider PSA + DRE if:

Answer 14

Nocturia, frequency, hesitancy, urgency, retention
Erectile dysfunction
Visible haematuria

Question 15

PSA threshold 40-49y

Answer 15

> 2.5 mcg/L

Question 16

PSA threshold 50-59y

Answer 16

> 3.5 mcg/L

Question 17

PSA threshold 60-69y

Answer 17

> 4.5 mcg/L

Question 18

PSA threshold 70-79y

Answer 18

> 6.5 mcg/L

Question 19

2ww for bladder cancer if >45y and:

Answer 19

Unexplained visible haematuria without UTI/after successfully treated

Question 20

2ww for bladder cancer if >60y + unexplained non-visible haematuria and:

Answer 20

Dysuria
Raised WCC

Question 21

Consider non-urgent bladder cancer referral if:

Answer 21

> 60y + persistent/recurrent unexplained UIT

Question 22

Consider 2ww for penile cancer if:

Answer 22

Penile mass/ulcerated lesion + STI excluded/treated
Unexplained/persistent foreskin or glans symptom

Question 23

2ww for melanoma if:

Answer 23

Suspicious pigmented lesion >=3 points on 7-p checklist

Dermoscopy suggests melanoma

Question 24

Weighted 7-point check list:
Major features (2 points)

Answer 24

Change in size
Irregular shape
Irregular colour

Question 25

Weighted 7-point check list: Minor features (1 point)

Answer 25

>=7mm any diameter Inflammation Oozing Change in sensation

Question 26

*Consider* 2ww for melanoma if:

Answer 26

Pigmented/non-pigmented lesion suggests nodular melanoma

Question 27

*Consider* 2ww for skin cancer if:

Answer 27

Lesion suspicious for SCC Lesions suspicious for BCC + avoiding delay due to site/size

Question 28

Consider routine referral for skin cancer if:

Answer 28

Suspicious for BCC

Question 29

*Consider* 2ww for prostate cancer if:

Answer 29

LUTs/erectile dysfunction/visible haematuria + PSA over threshold

Question 30

2ww for renal cancer if >45y and:

Answer 30

Unexplained visible haematuria without UTI/after successfully treated