NICE 2ww referral criteria - 3

Question 1

Consider 2ww for laryngeal cancer if >45y +

Answer 1

Unexplained persistent hoarseness
Unexplained neck lump

Question 2

Consider 2ww for oral cancer if:

Answer 2

Unexplained oral ulcer >3wks
Unexplained persistent neck lump

Question 3

Consider 2-week dental referral if:

Answer 3

Lip/oral lump
Red/red+white oral patch
(erythroplakia/erythroleukoplakia)

Question 4

Dentist to consider 2ww for oral cancer if:

Answer 4

Lip/oral lump consistent oral cancer
Patch consistent with erythroplakia/erythroleukoplakia

Question 5

Consider 2ww for thyroid cancer if:

Answer 5

Unexplained thyroid lump

Question 6

Consider urgent direct-access MRI for CNS cancer in adult with:

Answer 6

Progressive subacute loss of central neurological function

Question 7

Consider 48hr referral for CNS cancer in CYP with:

Answer 7

New abnormal cerebellar/CNS function

Question 8

Consider very urgent (48hr) FBC to assess for leukaemia in adult with

Answer 8

• pallor
• persistent fatigue
• unexplained fever
• unexplained persistent/recurrent infection
• generalised lymphadenopathy
• unexplained bruising
• unexplained bleeding
• unexplained petechiae
• hepatosplenomegaly

Question 9

Child with unexplained petechiae

Answer 9

Refer for immediate specialist assessment (suspected leukaemia)

Question 10

Child with hepatosplenomegaly

Answer 10

Refer for immediate specialist assessment (suspected leukaemia)

Question 11

Offer very urgent (48hr) FBC to assess for leukaemia in child with

Answer 11

• pallor
• persistent fatigue
• unexplained fever
• unexplained persistent infection
• generalised lymphadenopathy
• unexplained bone pain
• unexplained bruising
• unexplained bleeding

Question 12

> 60y with persistent bone pain

Answer 12

Offer:
FBC, calcium profile, ESR/viscosity
(myeloma)

Question 13

> 60y with unexplained fracture

Answer 13

Offer:
FBC, calcium profile, ESR/viscosity
(myeloma)

Question 14

> 60y with symptoms of myeloma + hypercalcaemia/le

Answer 14

Offer very urgent (48hr): protein electrophoresis
+
Bence-Jones urine test

Question 15

Symptoms of myeloma + raised ESR/viscosity

Answer 15

Consider very urgent (48hr): protein electrophoresis
+
Bence-Jones urine test

Question 16

Protein electrophoresis/Bence-Jones urine suggest myeloma

Answer 16

2ww referral for suspected cancer (myeloma)

Question 17

Unexplained lymphadenopathy in adult

Answer 17

Consider 2ww referral for suspected cancer (HL/NHL)

Question 18

Unexplained splenomegaly in adult

Answer 18

Consider 2ww referral for suspected cancer (NHL)

Question 19

Unexplained lymphadenopathy in child

Answer 19

Consider very urgent referral (48hr) for specialist assessment (HL/NHL)

Question 20

Unexplained splenomegaly in child

Answer 20

Consider very urgent referral (48hr) for specialist assessment (NHL)

Question 21

Xray suggests possible bone sarcoma in adult

Answer 21

Consider 2ww referral for suspected cancer

Question 22

Xray suggests possible bone sarcoma in child

Answer 22

Consider very urgent referral (48hr) for specialist assessment

Question 23

Child with unexplained bone swelling/pain

Answer 23

Consider very urgent (48hr) direct-access Xray
(bone sarcoma)

Question 24

Adult with unexplained lump increasing in size

Answer 24

Consider urgent (2 week) direct access US
(soft tissue sarcoma)

Question 25

Adult with US findings suggestive of soft tissue sarcoma

Answer 25

Consider 2ww referral for suspected cancer

Question 26

Child with unexplained lump increasing in size

Answer 26

Consider very urgent (48hr) direct access US
(soft tissue sarcoma)

Question 27

Child with US findings suggestive of soft tissue sarcoma

Answer 27

Consider very urgent referral (48hr) for specialist assessment

Question 28

Child with palpable abdominal mass

Answer 28

Consider very urgent referral (48hr) for specialist assessment
(neuroblastoma/Wilm’s tumour)

Question 29

Child with absent red reflex

Answer 29

Consider urgent (2 week) ophthalmology referral
(retinoblastoma)

Question 30

Child with unexplained enlarged abdominal organ

Answer 30

Consider very urgent referral (48hr) for specialist assessment
(neuroblastoma/Wilm’s tumour)

Question 31

Child with unexplained visible haematuria

Answer 31

Consider very urgent referral (48hr) for specialist assessment
(Wilm’s tumour)

Question 32

For which symptoms in adults must you assess for additional findings + offer urgent investigation or 2ww referral

Answer 32

Unexplained weight loss

Unexplained appetite loss

DVT