Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

Head & Neck incl Thyroid - 2WW

Checked: 25-11-2022 by vicky.ryan Next Review: 25-11-2023

Service Overview

Service provided by UHBristol at the Bristol Royal Infirmary. The services are for patients who meet the Head and Neck Cancer (including Thyroid) 2WW criteria.

Contact details ADULT 2WW:

UHBW - Tel on 0117 342 7641 / 2 / 3 / 4 or email to

The service offers consultation with diagnostics and onward referral for treatment as required.

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

Referral Guidance

Referrals should be made using the Suspected Head & Neck Cancer Referral Form (word doc).

MDT referrals - If advised to refer into MDT, then please submit a 2WW referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

Suspected Head and Neck Cancer  - General (Dentists should refer via GP) :

  • An unexplained palpable lump in the neck i.e. of recent onset or a previously undiagnosed lump that has changed over a period of 3 – 6 weeks (Please note: Patients with neck lumps meeting 2WW criteria should be referred via the 2WW pathway to request investigation. Do not arrange a neck USS outside of this pathway as this can lead to delays. For neck lumps not meeting 2WW criteria, please see advice on the USS guidance page)

  • An unexplained persistent swelling in the parotid or submandibular gland

If there is widespread lymphadenopathy above and below diaphragm / B symptoms, please use the Haematology - 2WW pathway.

Suspected Head and Neck Cancer – Ear, Nose and Throat Origin (Dentist should refer via GP) :

  • Persistent unexplained hoarseness i.e. >3 weeks, with negative chest X-ray (consider)

  • An unexplained persistent sore throat, especially if associated with dysphagia, hoarseness or otalgia.

  • Persistent unilateral nasal obstruction with bloody discharge*

  • Unexplained unilateral serous otitis media/ effusion in a patient aged over 18

* Other red flags for nasopharyngeal malignancy may also warrant 2WW referral and will be accepted if concern is free texted on the 2WW form even if box is not ticked. See nasal treatment section of Remedy for further details.

Suspected Thyroid Cancer (Dentist should refer via GP):

  • Unexplained thyroid lump (consider). Please perform thyroid function test in parallel with referral.

  • If there are concerning symptoms e.g., signs of airway obstruction contact on call ENT team.

Suspected Head and Neck Cancer - Oral Maxillo-Facial Origin (Dentists can refer direct, use the referral form and send to

  • Unexplained ulceration of the oral cavity or mass persisting for more than 3 weeks (consider)

  • Unexplained red and white patches (including suspected lichen planus) of the oral cavity particularly if painful, bleeding or swollen (consider)

  • Oral cavity and lip lesions or persistent symptoms of the oral cavity followed up for six weeks where definitive diagnosis of a benign lesion cannot be made

  • Non-healing extraction sockets (>4 weeks duration) or suspicious loosening of teeth, where malignancy is suspected (particularly if associated with numbness of the lip) 

Clinical Guidance

Please see NICE Cancer Guidelines 2015 for Head and Neck Cancers


Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.