Information from Cancer Research UK

Referral decision guide

This practical tool illustrates the signs and symptoms that should prompt urgent referral to secondary care via the suspected cancer pathway.

Click on the recommendations below to view the signs and symptoms that indicate urgent referral.

The National Institute for Health and Care Excellence (NICE) suspected cancer referral guidelines1

Consider a suspected cancer pathway referral* 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

GPs

Consider an urgent referral* for assessment for possible oral cancer by a dentist (see Cancer Research UK (CRUK) recommendation below) 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

Dentists

Consider a suspected cancer pathway referral by the dentist* 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

Consider a suspected cancer pathway referral* for thyroid cancer in people with an unexplained thyroid lump.

*for an appointment within 2 weeks

 

Read the full NICE guidelines on suspected cancer for more information

CRUK recommends that both GPs and dentists should consider referring to secondary care for all oral cancer signs and symptoms featured in NICE guidance, without the need for cross referral from GPs to dentists for assessment of symptoms. The reasons for this are:

  • cross referral from GP to dentist introduces an additional step and potential delay into the diagnostic pathway for patients
  • many people do not have a dentist and dental practices won’t always have the capacity to take on new NHS patients 
  • visiting a dentist is associated with financial outlay, which can present a barrier for some patients
  • the extra step may confuse/ inhibit patients from attending further appointments

Healthcare Improvement Scotland referral guidelines for suspected cancer2

Consider an urgent suspicion of cancer referral for head and neck cancer in people with the following symptoms:

  • Persistent unexplained head and neck lumps >3 weeks
  • Ulceration or unexplained swelling of the oral mucosa persisting for >3 weeks
  • All red or mixed red and white patches of the oral mucosa persisting for >3 weeks
  • Persistent hoarseness lasting for >3 weeks (request a chest X-ray at the same time)
  • Dysphagia or odynophagia (pain on swallowing) lasting for >3 weeks
  • Persistent pain in the throat lasting for >3 weeks

Consider an urgent suspicion of cancer referral for thyroid cancer in people with the following symptoms:

  • Solitary nodule increasing in size
  • Thyroid swelling in a pre-pubertal patient
  • Thyroid swelling with one or more of the following risk factors:
    • neck irradiation
    • family history of endocrine tumour
    • unexplained hoarseness
    • cervical lymphadenopathy

Read the full Healthcare Improvement Scotland referral guidelines for suspected cancer for more information

View the lesion recognition resource ›

References

  1. National Insititute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral [NG12]. June 2015. Available at: https://www.nice.org.uk/guidance/ng12. Accessed October 2017
  2. Healthcare Improvement Scotland. Scottish referral guidelines for suspected cancer. August 2014. Available at: http://www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/programme_resources/scottish_referral_guidelines.aspx. Accessed October 2017

Acknowledgements

Cancer Research UK would like to acknowledge the following clinicians for their invaluable input into the development of the Oral Cancer Recognition Toolkit:
Professor Richard Shaw, Professor Peter Brennan, Professor Saman Warnakulasuriya, Dr Afsana Safa, Mr Craig Wales, Professor Mark McGurk, Professor Crispian Scully and Dr Nigel Carter.

Oral cancer risk factors

Some of the risk factors associated with oral cancer include:

  • age
  • tobacco use (smoking and chewing)
  • betel quid (areca nut) use
  • alcohol consumption
  • human papillomavirus infection
  • low fruit and vegetable consumption

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