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'Referral advice' recommendation details

Referral for suspected cancer

Results 21-30 of 53

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG27 Patients with persistent or slowly evolving unresponsive skin conditions in which the diagnosis is uncertain and cancer is a possibility should be referred to a dermatologist. Time frame not specified
CG27 All primary healthcare professionals should use the weighted 7-point checklist in the assessment of pigmented lesions to determine referral for suspicion of a malignant melanoma: - Major features of the lesions include change in size, irregular shape, irregular colour. - Minor features of the lesions include largest diameter 7 mm or more inflammation, oozing, change in sensation. Suspicion is greater for lesions scoring 3 points or more (based on major features scoring 2 points each and minor features scoring 1 point each). However, if there are strong concerns about cancer, any one feature is adequate to prompt urgent referral. Urgent
CG27 General recommendations regarding the referral of suspected head and neck cancers have been made: - A patient who presents with symptoms suggestive of head and neck or thyroid cancer should be referred to an appropriate specialist or the neck lump clinic, depending on local arrangements. - Any patient with persistent symptoms or signs related to the oral cavity in whom a definitive diagnosis of a benign lesion cannot be made should be referred or followed up until the symptoms and signs disappear. - If the symptoms and signs have not disappeared after 6 weeks, an urgent referral should be made. - Primary healthcare professionals should advise all patients, including those with dentures, to have regular dental checkups. Urgent
CG27 With regard to mouth cancer, a patient who presents with unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful, swollen or bleeding, an urgent referral should be made. A non-urgent referral should be made in the absence of these features. If oral lichen planus is confirmed, the patient should be monitored for oral cancer as part of routine dental examination. In patients with unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks, an urgent referral should be made. In adult patients with unexplained tooth mobility persisting for more than 3 weeks, an urgent referral to a dentist should be made. Urgent
CG27 With regard to suspected neck cancers, any patient with hoarseness persisting for more than 3 weeks, particularly smokers aged 50 years and older and heavy drinkers, an urgent referral for a chest X-ray should be made. Patients with positive findings should be referred urgently to a team specialising in the management of lung cancer. Patients with a negative finding should be urgently referred to a team specialising in head and neck cancer. In patients with an unexplained lump in the neck which has recently appeared or a lump which has not been diagnosed before that has changed over a period of 3 to 6 weeks, an urgent referral should be made. In patients with an unexplained persistent swelling in the parotid or submandibular gland, an urgent referral should be made. In patients with unexplained persistent sore or painful throat, an urgent referral should be made. In patients with unilateral unexplained pain in the head and neck area for more than 4 weeks, associated with otalgia (ear ache) but with normal otoscopy, an urgent referral should be made. With the exception of persistent hoarseness, investigations for head and neck cancer in primary care are not recommended as they can delay referral. Urgent
CG27 A patient who presents with symptoms suggestive of brain or central nervous system (CNS) cancer should be referred to an appropriate specialist, depending on local arrangements. If a primary healthcare professional has concerns about the interpretation of a patient's symptoms and/or signs, a discussion with a local specialist should be considered. If rapid access to scanning is available, this investigation should also be considered as an alternative. urgent
CG27 In any patient with symptoms related to the central nervous system (CNS) (including progressive neurological deficit, new-onset seizures, headaches,mental changes, cranial nerve palsy, unilateral sensorineural deafness) in whom a brain tumour is suspected, an urgent referral should be made. The development of new signs related to the central nervous system (CNS) should be considered as potential indications for referral. In patients previously diagnosed with any cancer an urgent referral should be made if the patient develops any of the following symptoms: recent-onset seizure, progressive neurological deficit, persistenIt headaches, new mental or cognitive changes or new neurological signs. urgent
CG27 Headaches: In patients with headaches of recent onset accompanied by either features suggestive of raised intracranial pressure or other focal or non-focal neurological symptoms (for example, blackout, change in personality or memory), an urgent referral should be made. In patients with unexplained headaches of recent onset, present for at least 1 month but not accompanied by features suggestive of raised intracranial pressure, discussion with a local specialist or referral (usually non-urgent) should be considered. In patients with a new, qualitatively different unexplained headache that becomes progressively severe, an urgent referral should be made. urgent
CG27 Seizures: In any patient with suspected recent-onset seizures, an urgent referral to a neurologist should be made. Suspected brain cancer: In patients with rapid progression of subacute focal neurological deficit, unexplained cognitive impairment, behavioural disturbance, or slowness or a combination of these personality changes confirmed by a witness (for example, a carer, friend or a family member) and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour an urgent referral to an appropriate specialist should be considered. urgent
CG27 A patient who presents with symptoms suggesting bone cancer or sarcoma should be referred to a team specialising in the management of bone cancer and sarcoma, or to a recognised bone cancer centre, depending on local arrangements. A patient with a suspected spontaneous fracture should be referred for an immediate X-ray. If an X-ray indicates that bone cancer is a possibility, an urgent referral should be made. If the X-ray is normal but symptoms persist, the patient should be followed up and/or a repeat X-ray or bone function tests or a referral requested. In patients presenting with a palpable lump, an urgent referral for suspicion of soft tissue sarcoma should be made if the lump is greater than about 5 cm in diameter, deep to fascia, fixed or immobile, painful, increasing in size, a recurrence after previous excision. If there is any doubt about the need for referral, discussion with a local specialist should be undertaken. If a patient has HIV disease, Kaposi's sarcoma should be considered and a referral made if this is suspected. Immediate

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.