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2 Week Wait > Head & Neck – 2WW


Head & Neck – 2WW

  

Information and referral forms for 2WW Head and Neck

Reviewed on : 15 Jun 2022

Reviewed by : GP Gateway Editor

Expires : 15 Jun 2024

TWO WEEK REFERRAL SERVICES – HEAD AND NECK

Clinical Guidance for Primary Care

LARYNX – Persistent unexplained hoarseness lasting for > 3/52

Whom to refer

  • Persistent and progressive change in voice, especially in smokers and it should be a constant symptom
  • Unilateral persistent sore throat

Whom not to refer

  • Intermittent croaky voice

Suggested Management

  • Laryngitis after URTI- loss of voice
  • Voice rest for a week. Steam inhalation, hydration
  • Intermittent Voice symptoms-LPR and poor oral hydration
  • PPI, lifestyle advice, increase frequent hydration for 6/52, routine ENT referral
  • Long standing voice symptoms – Cyst/polyp/nodules
  • Refer to routine ENT

PHARYNX – Unexplained, persistent sore throat for >3/52

Whom to refer

  • Ask if discomfort or painful throat

Usually unilateral, progressive pain throat

  • Pain while swallowing(odynophagia) – ipsilateral, persistent, and progressive
  • Pain in ear while swallowing (referred otalgia) – usually ipsilateral to the side of the cancer

 Whom not to refer

  • Repeated throat clearing
  • Sensation of lump in throat
  • Burning sensation in the lower throat

These could be caused by poor oral hygiene, LPR or Globus

Suggested Management

  • Frequent hydration
  • Gaviscon Advance for 6/52
  • Lifestyle advice
  • Stop repeated throat clearing
  • Information leaflet
  • If persistent after 6 weeks with no progressive or new symptoms, consider routine ENT referral
  • If patient is around 40 years and develops red flag symptoms, refer on 2ww

PERSISTENT UNEXPLAINED LUMP IN NECK > 3/52

Whom to refer

  • Palpable neck lump – firm, hard and non-tender
  • Recently notices asymmetric tonsils
  • With other red flag symptoms

Whom not to refer

Sensation of lump in throat (Globus) with no red flag symptoms

 

 

UNEXPLAINED THYROID LUMP

 

 

SALIVARY GLAND SWELLING 

Refer:

  • Lump with no preceding infection
  • Non tender, progressive, well defined palpable lump
  • Previous skin cancers with palpable lumps

Do not refer:

  • Recent parotitis
  • Recurrent parotitis
  • Palpable or previous history of salivary calculi

ENT SYMPTOMS:

GLOBUS PHARYNGEUS ASSESSMENT & MANAGEMENT

 

TINNITUS & VERTIGO

  • Not a cancer symptom – routine ENT referral
  • If patient needs reassurance for U/L tinnitus – refer for routine MRI Internal Auditory Meatus to exclude Cerebello-pontine lesions

ALLERGIC RHINITIS

Cancer Research UK

On referral consider handing 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)

2WW Referral Form 2022

To print form follow referral link right

 

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UPDATED VERSION 2WW HEAD & NECK

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