Referral

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Head and neck 2WW

Scope

This guidance covers the referral of a patient who presents with symptoms suggestive of head and neck or thyroid cancer to an appropriate specialist or the neck lump clinic, depending on local arrangements.

GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.

Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.

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With the exception of persistent hoarseness, investigations are not recommended as they can delay referral.

Thyroid Cancer Investigations

  • Primary care initiation of investigations such as ultrasonography or isotope scanning is not recommended.
  • Request thyroid function tests in patients with a thyroid swelling without stridor or any of the features listed below.

Refer patients with hyper or hypothyroidism and an associated goitre, non-urgently, to an endocrinologist. Patients with goitre and normal thyroid function tests without any of the features listed above should be referred non-urgently.

With the exception of persistent hoarseness, investigations are not recommended as they can delay referral.

Referral Criteria

Suspected Head and Neck Cancer - General:

  • An unexplained lump in the neck i.e. of recent onset or a previously undiagnosed lump that has changed over a period of 3 – 6 weeks
  • An unexplained persistent swelling in the parotid or submandibular gland

Suspected Head and Neck Cancer – Ear, Nose and Throat Origin:

  • Persistent unexplained hoarseness ie more than 3 weeks, with negative chest X-ray (consider)
  • An unexplained persistent sore throat especially if associated with dysphagia, hoarseness or otalgia
  • Referred otalgia as a symptom of laryngeal or pharyngeal malignancy
  • Dysphagia with obstruction in pharynx of cervical oesophagus
  • Persistent unilateral nasal obstruction with bloody discharge
  • Unexplained serous otitis media/ effusion in a patient aged over 18

Suspected Thyroid Cancer:

  • Unexplained thyroid lump (consider referral)

It would be very helpful if a thyroid function test result less than 8 weeks old could be provided

Suspected Head and Neck Cancer – Oral Maxillo-Facial Origin

  • Unexplained ulceration of the oral cavity or mass persisting for more than 3 weeks (consider)
  • Unexplained red and white patches (including suspected linchen planus) of the oral cavity particularly if painful, bleeding or swollen (consider).
  • Oral cavity and lip lesions or persistent symptoms of the oral cavity followed up for six weeks where definitive diagnosis of a benign lesion cannot be made
  • Non-healing extraction sockets (more than 4 weeks duration) or suspicious loosening of teeth, where malignancy is suspected (particularly if associated with numbness of the lip)

Please note: unilateral sensorineural hearing loss is not a symptom of head and neck cancer. Please refer patients with this symptom via the normal channels.

Referral Instructions

The GP should use e-Referral Service to book an appointment or send referral.

Please ensure you include:

  • The patient's NHS number
  • Tell the patient that this is an urgent referral and they will be seen within 14 days

e-Referral selection:

  • Specialty: 2WW
  • Clinic Type: 2WW Head & Neck
  • Service selection: Two Week Wait Ear, Nose & Throat RAS **NOT THYROID LUMPS**-ENT-RDE-RH8 / Two Week Wait Maxillo Facial Cancers RDE-RH8 / Two Week Wait Thyroid Lump Only -RDE-RH8

Please ensure that referrals are booked or sent to the Referral Assessment service via NHS e-Referral Service. If no slots are available please defer to provider and the RDE will book the appointment and contact the patient. Please also ensure that referral letters are attached to the system within 24 hours to enable us to book pre appointment tests and scans timely.

For any patients that you are unable to process through NHS e-Referral please contact the drss.helpdesk@nhs.net

Referral Forms

Suspected Head and Neck cancer referral form - No merge fields

Suspected Head and Neck cancer referral form - EMIS

Suspected Head and Neck cancer referral form - SystmOne 

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