Reviewed on : 5 Nov 2025

Reviewed by : Olivia Bowers

Expires : 29 Oct 2027

HAEMATOLOGY URGENT SUSPECTED CANCER (2WW)

Indications for an urgent referral for a suspected new malignancy are:

• FBC with film report suggesting acute leukaemia or chronic myeloid leukaemia
• Possible myeloma as suggested by paraprotein (IgG >15g/L, or IgA or IgM >10g/L, or abnormal serum free light chain ratio >7, or <0.1)
• OR paraprotein of any level with unexplained anaemia, worsening renal function or hypercalcaemia or radiology suggestive of myeloma
• Lymphadenopathy>2cm or increasing in size and persistent for > 6 weeks and NOT isolated in NECK or AXILLA
• Unexplained (e.g. no known liver disease) splenomegaly >20cm on imaging (Enlarged spleens are often picked up on US by sonographers and do not suggest a haematological problem unless very big or associated with an abnormal FBC)

Exclusions

These clinical problems are NOT suitable for referral to Haematology as a 2WW:

• Iron deficiency (new): refer as appropriate to GI /Gynae/NSS. If sinister pathology excluded then haematology Advice and Guidance.
• Neck lumps – all neck lumps including neck nodes should be referred on the appropriate Head and Neck pathway
• Axillary lumps – refer on Breast Pathway
• Blood film suggesting Chronic Lymphocytic Leukaemia (CLL) or other lymphoproliferative disorder: refer routinely to Haematology OPD

In the setting of an abnormal FBC and clinical concern, discuss with Haematology via Advice and Guidance or the Duty Haematologist by telephone if urgent

Please hand the patient a Cancer Research UK Information Sheet – follow link

Two Week Wait referrals should now be processed through the NHS eReferral Service (previously known as Choose & Book)