Referral pathways - 2 week wait for each cancer

Question 1

Criteria for suspected lung cancer 2 week wait referral for a chest X ray

Answer 1

Aged 40 or over with at least one of these symptoms or if they have ever smoked and have one of these symptoms:
1. cough
2. fatigue
3. SOB
4. chest pain
5. weight loss
6. reduced appetite

Question 2

Criteria for suspected lung cancer pathway referral if they have:

Answer 2

CXR suggestive of lung cancer

Aged over 40 with unexplained haemoptysis

Question 3

When do you offer urgent, direct access upper gastrointestinal endoscopy (to be done within 2 weeks) to assess for oesophageal cancer?

Answer 3

Dysphagia alone is enough for referral but can be referred if the patient is over 55 with dyspepsia, reflux and upper abdo pain.

THIS IS ALSO THE SAME FOR STOMACH CANCER.

Question 4

When do you consider an urgent, direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60?

Answer 4

Weight loss +

new onset diabetes
jaundice
change in bowel habit
nausea and loss of appetite

Question 5

What is the criteria for offering Faecal immunochemical testing for patients in suspected Colorectal cancer?

Answer 5

Offer quantitative faecal immunochemical testing (FIT) if the patient has:

an abdominal mass, or

a change in bowel habit, or

iron-deficiency anaemia, or

aged 40 and over with unexplained weight loss and abdominal pain, or

aged under 50 with rectal bleeding

Question 6

When do you refer for the 2 week wait based on the FIT result?

Answer 6

Refer adults using a suspected cancer pathway referral for colorectal cancer if they have a FIT result of at least 10 micrograms of haemoglobin per gram of faeces.

Question 7

What is the criteria for suspected anal cancer 2 week wait referral?

Answer 7

1. unexplained anal mass
2. unexplained anal ulceration

Question 8

When do you refer a patient using the suspected cancer pathway for breast cancer? (30 and over)

Answer 8

• unexplained breast lump or in the axillae
• without pain

Question 9

When do you refer a patient using the suspected cancer pathway for breast cancer? (50 and over)

Answer 9

• discharge
• retraction of skin
• inverted nipple
• skin changes

Question 10

When do you make a referral to gynaecological cancer service for suspected cancer pathway referral for ovarian cancer?

Answer 10

• Patient has ascites and / or pelvic mass which is not uterine fibroids
  OR
• persistent abdominal distension
• feeling full, early satiety or loss of appetite
• pelvic or abdominal pain
• increased urinary urgency or frequency

Question 11

How does CA125 level affect the referral of ovarian cancer?

Answer 11

If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.

Question 12

When do you refer using the suspected cancer pathway referral for endometrial cancer?

Answer 12

1. aged 55+ with post menopausal bleeding (After 12 months after last period)
2. unexplained discharge
3. report haematuria

Question 13

When do you refer people using a suspected cancer pathway referral for prostate cancer?

Answer 13

• prostate feels enlarged and irregular in shape on digital rectal exam

Question 14

When to consider a prostate‑specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in people with:

Answer 14

1. Any lower urinary tract symptoms e.g. nocturia, urinary frequency, hesitancy, urgency or retention
2. erectile dysfunction
3. visible haematuria

Question 15

Results for PSA: when do you refer?

Answer 15

Aged 40-49, more than 2.5
50-59: >3.5
60-69: >4.5
70-79: >6.5

Question 16

When do you refer people using a suspected cancer pathway referral for bladder cancer?

Answer 16

aged 45+
unexplained visible haematuri without UTI
OR
visible haematuria that persists or recurs after successful UTI treatment
OR
AGED 60+
dysuria and raised WCC on blood test and no visible haematuria

Question 17

When do you refer people using a suspected cancer pathway referral for renal cancer?

Answer 17

Aged 45+
unexplained visible haematuria without urinary tract infection

or

visible haematuria that persists or recurs after successful treatment of urinary tract infection.

Question 18

When to consider suspected cancer pathway referral for testicular cancer in men:

Answer 18

1. Non painful enlargement or change in shape and texture of the testis
2. DIRECT ACCESS ultrasound considered in men with consistent testicular symptoms