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REMEDY : BNSSG referral pathways & Joint Formulary

Head & Neck incl Thyroid - 2WW

Checked: 15-07-2020 by vicky.ryan Next Review: 17-06-2021

Service Overview

Service provided by UHBristol at the Bristol Royal Infirmary. The services are for patients who meet the Head and Neck Cancer (including Thyroid) 2WW criteria.

The service offers consultation with diagnostics and onward referral for treatment as required.

At time of referral please issue the patient information leaflet below:

BNSSG  2WW Patient Information Leaflet. - COVID-19 Edition

Link to leaflet on CCG website: https://bnssgccg.nhs.uk/library/understanding-two-week-wait-urgent-referrals-and-covid-19/

Referral Guidance

Referrals should be made using the Head & Neck 2WW proforma (word doc).

Suspected Head and Neck Cancer  - General (Dentist should refer via GP) :

  • An unexplained palpable 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 (Dentist should refer via GP) :

  • Persistent unexplained hoarseness i.e. >3 weeks, with negative chest X-ray (consider)

  • An unexplained persistent sore throat, especially if associated with dysphagia, hoarseness or otalgia.

  • Persistent unilateral nasal obstruction with bloody discharge*

  • Unexplained unilateral serous otitis media/ effusion in a patient aged over 18

* Other red flags for nasopharyngeal malignancy may also warrant 2WW referral and will be accepted if concern is free texted on the 2WW form even if box is not ticked. See nasal treatment section of Remedy for further details.

Suspected Thyroid Cancer (Dentist should refer via GP):

  • Unexplained thyroid lump (consider). Please perform thyroid function test in parallel with referral.

Suspected Head and Neck Cancer - Oral Maxillo-Facial Origin (Dentists can refer direct, use the referral form and send to ubh-tr.fast-trackreferrals@nhs.net):

  • Unexplained ulceration of the oral cavity or mass persisting for more than 3 weeks (consider)

  • Unexplained red and white patches (including suspected lichen 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 (>4 weeks duration) or suspicious loosening of teeth, where malignancy is suspected (particularly if associated with numbness of the lip) 

Clinical Guidance

Please see NICE Cancer Guidelines 2015 for Head and Neck Cancers