TWO WEEK REFERRAL SERVICES – HEAD AND NECK
Clinical Guidance for Primary Care
ORAL
Whom to refer
- Persistent Oral Ulceration > 3weeks
- Persistent lump on lip consistent with oral cancer
- Persistent red/white lesions in the oral cavity consistent with oral cancer
Whom not to refer:
- Persistent intermittent ulceration
- Recurrent oral ulceration with resolution between episodes
- Intermittent swelling of the lip
- Routine periodontal disease
- Intermittent red/white lesions which resolve and recur
Refer all these for routine maxillofacial appointment
NOTE: Urgent referrals for cysts and dental pathology should be made to the maxillofacial department and NOT referred via 2WW.
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 or head and neck 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
OTHER EAR PROBLEMS
- Suspected cholesteatoma should be referred urgently to otology and not via 2WW
- Suspected acoustic neuroma should be referred urgently to otology and not via 2WW
- Sudden onset unilateral deafness should be referred urgently to otology and not via 2WW
UNILATERAL NASAL BLOCKAGE
- UNLESS bloody discharge, patients should be referred to routine ENT clinics
ALLERGIC RHINITIS
This is not a cancer symptom and should be referred for a routine ENT appointment
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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