Two week wait referral

Question 1

Urgent referral for lung cancer (2)

Answer 1

CXR findings suggestive of lung cancer

.>40 and haemoptysis

Question 2

Urgent CXR in <2 weeks criteria (2)

Answer 2

> 40 with 2+

or Smoking Hx 1+

• cough
• fatigue
• SOB
• Chest pain
• Weight loss
• Appetite loss

Question 3

Consider urgent CXR (1)

Answer 3

> 40 and 1 of

• persistent or recurrent chest infection
• clubbing
• supraclavicular / cervical lymphadenopathy

Question 4

Urgent 2ww to endoscopy (2)

Answer 4

Dysphagia

> 55 Weight loss +

• upper abdo pain
• reflux
• dyspepsia

Question 5

When to consider a non urgent referral to endoscopy (2)

Answer 5

Haematemsis

> 55 +

• treatment resistant dyspepsia
• upper abdo pain and low Hb
• raised platelet count and one of: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdo pain.
• N&V with one of: weight loss, reflux, dyspepsia, upper abdo pain.

Question 6

TWW referral for pancreatic cancer (1)

Answer 6

> 40 with Jaundice

Question 7

Urgent referral for CT/ Abdo US (for pancreatic cancer) (1)

Answer 7

> 60 with weight loss and one of:

• diarrhoea
• back pain
• abdo pain
• nausea
• vomiting
• constipation
• new onset DM

Question 8

Urgent referral for US <2 weeks for Liver / Gallbladder

Answer 8

Upper abdo mass consistent with enlarged liver / gall bladder

Question 9

Colorectal 2WW referral

3

Answer 9

> 40 and unexplained weight loss and abdo pain

> 50 with unexplained rectal bleeding

60 w/ one of:

• iron deficiency anaemia
• change in bowel habit
• occult blood faeces

Question 10

Consider Colorectal 2WW referral

2

Answer 10

• Rectal or abdo mass
• <50 with any of:
• abdo pain
• change in bowel habit
• weight loss
• iron deficiency anaemia

Question 11

Breast 2 ww referral (2)

Answer 11

> 30 unexplained breast lump

> 50 with any from one nipple

• discharge
• retraction
• other changes of concern

Question 12

Consider breast 2ww referral (2)

Answer 12

• skin changes that suggest breast cancer

- 30 and unexplained lump in the axilla

Question 13

Non urgent breast referral

Answer 13

<30 unexplained breast lump with or without pain

Question 14

Urgent referral to gynaecology (1)

Answer 14

physical exam identifies ascites or pelvix / abdo mass

Question 15

When to carry out CA125 then US (2)

Answer 15

> 50 with IBS sx in last 12m

or patients who’s symptoms suggest ovarian cancer

Question 16

CA125 significant level

Answer 16

35

Question 17

2WW referral for endometrial cancer (1)

Answer 17

> 55 with post-menopausal bleeding

Question 18

consider 2WW referral for endometiral cancer !1)

Answer 18

<55 with post-menopausal bleeding

Question 19

Cervical 2WW (1)

Answer 19

Appearance of cervix is consistent with cervical cancer

Question 20

Vulval 2WW (1)

Answer 20

Unexplained vulval lump, ulceration or bleeding

Question 21

Vaginal 2WW (1)

Answer 21

unexplained palpable mass in or at entrance to vagina

Question 22

Prostate 2WW (2)

Answer 22

Prostate feels malignant on DRE

PSA levels above age specific range

Question 23

When to consider PSA and DRE (3)

Answer 23

Men with one of:

• LUTS
• Erectile dysfunction
• Visible haematuria

Question 24

Bladder 2WW (2)

Answer 24

> 45 with one of:

• unexplained visible haematuria with no UTI
• visible haematuria that persists or recurs after treatment of UTI

OR

> 1 unexplained non visible haematuria and dysuria or raised WCC

Question 25

Melanoma 2WW referall (2)

Answer 25

1) Dermatoscopy suggests melanoma
2) >3 in check list

2 points

• change in size
• irregular shape
• irregular colour

1 points

• 7mm or more
• inflammation
• oozing
• change in sensation