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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.

Head and Neck Cancer

Urgent Referral

Refer urgently patients with

  • an unexplained lump in the neck, of recent onset, or a lump that has changed over a period of 3 to 6 weeks
  • an unexplained persistent swelling in the parotid or submandibular gland
  • an unxplained persistent sore or painful throat
  • unilateral unexplained pain in the head and neck area for more than 4 weeks, associated with otalgia but a normal otoscopy
  • unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks
  • unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful or swollen or bleeding
  • hoarseness for more than 6 weeks


Thyroid Cancer

Immediate Referral

  • Refer immediately patients with symptoms of tracheal compression including stridor due to thyroid swelling

Urgent Referral

Refer urgently patients with a thyroid swelling associated with any of the following

  • a solitary nodule increasing in size
  • a history of neck irradiation
  • a family history of endocrine tumour
  • unexplained hoarseness or voice changes
  • cervical lymphadenopathy
  • pre-pubertal patient
  • patient aged 65 or older




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Last Update: 31 January 2008