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  Two-Week Wait Rule - Suspected Cancer  
Referral Guidelines for Suspected Cancer (Two week wait rule) based on NICE Guidance 2005
Last Updated October 2012.

Bone Tumours

Immediate X-ray

Refer for an immediate X-ray a patient with a suspected spontaneous fracture.

If the X-ray:

  • Indicates possible bone cancer, refer urgently
  • Is normal but symptoms persist, follow up and/or request repeat X-ray, bone function tests or referral


Soft Tissue Sarcoma

Urgent Referral

Refer urgently if a patient presents with a palpable lump that is:

  • Greater than about 5cm in diameter
  • Deep to fascia, fixed or immobile
  • Increasing in size
  • Painful
  • A recurrence after previous excision
  • If a patient has HIV, consider Kaposi's sarcoma and make an urgent referral if suspected

Urgent Investigation

Urgently investigate increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained lump. In older people, metastases, myeloma or lymphoma, as well as sarcoma, should be considered. Refer under Two-Week Wait if positive




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Last Update: 31 January 2008