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Referral
Neurology
This guidance covers the referral of a patient who presents with symptoms suggestive of brain or CNS cancer to an appropriate specialist, depending on local arrangements.
Discuss any concerns about a patient's symptoms and/or signs with a local specialist. If rapid access to scanning is available, consider as an alternative to referral
Re-assessment and re-examination is required if the patient does not progress according to expectations
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
Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:
- recent-onset seizure
- progressive neurological deficit
- persistent headaches
- new mental or cognitive changes
- new neurological signs
In a patient with new, unexplained headaches or neurological symptoms, undertake a neurological examination guided by the symptoms, but including examination for papilledema. Note that the absence of papilledema does not exclude the possibility of a brain tumour.
When a patient presents with seizure, take a detailed history from the patient and an eyewitness to the event. Carry out a physical examination, including cardiac, neurological and mental state, and developmental assessment, where appropriate.
Referral Instructions
- The GP should use e-Referral Service to book the appointment
- Service: 2WW
- Clinic type: 2WW Brain
- Service: Two Week Wait Brain/CNS -RDE-RH8
- Tell the patient the appointment details
Refer patient urgently with symptoms related to the CNS, including:
- progressive neurological deficit
- new-onset seizures
- headaches
- mental changes
- cranial nerve palsy
- unilateral sensor neural deafness in whom a brain tumour is suspected
- headaches of recent onset accompanied by features suggestive of raised intracranial pressure, for example:
- vomiting
- drowsiness
- posture-related headache
- pulse-synchronous tinnitus or by other focal or non-focal neurological symptoms, for example blackout, change in personality or memory
- a new, qualitatively different, unexplained headache that becomes progressively severe
- suspected recent-onset seizures (refer to neurologist)
Consider urgent referral (to an appropriate specialist) in patients with rapid progression of:
- sub acute focal neurological deficit
- unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these
- personality changes confirmed by a witness and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour.
Consider non-urgent referral or discussion with specialist for:
- unexplained headaches of recent onset:
- present for at least 1 month
- not accompanied by features suggestive of raised intracranial pressure
Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:
- recent-onset seizure
- progressive neurological deficit
- persistent headaches
- new mental or cognitive changes
- new neurological signs
Please ensure that referrals are booked 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 24hours 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 Form
Suspected Brain & CNS cancer referral form - No Merge fields
Evidence
Link to full reference guide to NICE referral guidelines for suspected cancer
GP Information
Suspected Cancer Guidelines A-Z
NICE referral guidelines for suspected cancer
bmj - New NICE guidance on referral for cancer
bmj - Assessing and referring adult cancers infographic
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Patient Information
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Pathway Group
This guidance has been signed off on behalf of NHS Devon.
Publication date: November 2016
