
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
PREVIOUS HEAD & NECK 2WW FORM – PLEASE REMOVE FROM YOUR SYSTEM

UPDATED VERSION 2WW HEAD & NECK


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