Urgent referral for suspected neck cancer

Head and neck cancers

Laryngeal cancer

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:
  • persistent unexplained hoarseness or
  • an unexplained lump in the neck

Oral cancer

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
  • unexplained ulceration in the oral cavity lasting for more than 3 weeks or
  • a persistent and unexplained lump in the neck
    
    
• consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
  • a lump on the lip or in the oral cavity or
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
    
    
• consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either:
  • a lump on the lip or in the oral cavity consistent with oral cancer or
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

Thyroid cancer

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump

Notes:

• in the current NICE guidance there is no definition of duration of time for "persistent unexplained hoarseness" (1)
  • in previous NICE guidance there was suggested urgent referral if voice hoarseness persisted for greater than six weeks (2)
  • local guidance may vary with respect to length of duration of hoarseness before a two week referral should be initiated - Coventry local guidance suggests more than three weeks duration requires a two week referral (3)
• in previous guidance (2) urgent referrral was indicated for
  • unilateral nasal obstruction especially when associated with purulent discharge
  • if there is unexplained tooth mobility that is not associated with periodontal disease
  • also was noted that the level of suspicion of laryngeal and oral cancer is further increased if the patient is a heavy alcohol drinker or heavy smoker and is aged over 45 years and male. The chewing of tobacco (called Gutkha in India) or the chewing of Paan Masala or Betel should also increase the level of suspicion

Reference:

• NICE (June 2015). Suspected cancer: recognition and referral
• Referral Guidelines for Suspected Cancer (April 2000). NHS Executive.
• Coventry and Rugby CCG (June 2015). Head and neck cancer - two week referral guidance.