Two-week wait referral

Question 1

Lung cancer

1. Urgent CXR in <2 weeks criteria
2. Consider urgent CXR criteria
3. Urgent lung cancer referral criteria (2)

Answer 1

1. > 40 with 2 of (or smoking history and 1 of) - cough, fatigue, SOB, chest pain, weight loss, appetite loss
2. > 40 and 1 of - persistent/recurrent LRTI, clubbing, supraclavicular/cervical lymphadenopathy
3. CXR findings suggestive of lung cancer, or >40 and haemoptysis

Question 2

Endoscopy

1. Urgent 2ww (2)
2. Non-urgent referral

Answer 2

1. Dysphagia, or >55 Weight loss + upper abdominal pain/reflux/dyspepsia
2. Haematemesis, or >55 and treatment resistant dyspepsia, upper abdominal pain and low Hb, raised platelet count and one of N+V, weight loss, reflux, dyspepsia, upper abdominal pain

Question 3

Pancreatic cancer1

1. 2ww
2. Consider urgent CT/abdominal ultrasound

Answer 3

1. > 40 with Jaundice

2. 60+ with weight loss and one of - diarrhoea, back pain, abdominal pain, N+V, constipation, new onset DM

Question 4

Liver/Gallbladder

1. Urgent referral for US <2 weeks for Liver / Gallbladder

Answer 4

1. Upper abdominal mass consistent with enlarged liver / gall bladder

Question 5

Colorectal

1. Definite 2ww referral (3)
2. Consider 2ww referral

Answer 5

1. > 40 + unexplained weight loss + abdominal pain, >50 with unexplained rectal bleeding, or 60 w/ one of IDA, bowel habit change, occult faecal blood
2. Rectal/abdominal mass, or <50 and abdominal pain/bowel habit change/weight loss/IDA

Question 6

Breast

1. Definite 2ww referral
2. Consider 2ww referral
3. Non-urgent referral

Answer 6

1. > 30 unexplained breast lump, or >50 with discharge/retraction/other concerns from one nipple
2. Skin changes that suggest breast cancer, 30+ with unexplained axilla lump
3. <30 unexplained breast lump with or without pain

Question 7

Gynaecological

1. Urgent referral (1)
2. Definite endometrial 2ww referral (1)
3. Consider endometrial 2ww
4. Lower Cervical 2ww (1)
5. Vulval 2ww (1)
6. Vaginal 2ww (1)

Answer 7

1.. Physical exam identifies ascites or pelvic / abdominal mass

2. > 55 with post-menopausal bleeding
3. <55 with post-menopausal bleeding
4. Appearance of cervix is consistent with cervical cancer
5. Unexplained vulval lump, ulceration or bleeding
6. Unexplained palpable mass in or at entrance to vagina

Question 8

CA125

1. Linked malignancy
2. Significant level
3. When to carry out CA125 then US (2)

Answer 8

1. Ovarian
2. 35
3. > 50 with IBS symptoms in last year, or patients whose symptoms suggest ovarian cancer

Question 9

Prostate

1. When to consider PSA and DRE (3)
2. 2ww indication (2)

Answer 9

1. Men with LUTS / ED / visible haematuria

2. Prostate feels malignant on DRE, or PSA levels above age specific range

Question 10

Bladder 2ww (2)

Answer 10

> 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 11

Melanoma 2ww

Answer 11

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