Head & Neck incl. Thyroid - USC (2WW)

Service Overview

The service is provided by UHBW at the Bristol Royal Infirmary and is for patients who meet the Head and Neck Cancer (including Thyroid) USC (2WW) criteria.

Contact details ADULT USC:

UHBW - Tel on 0117 342 7641 / 2 / 3 / 4 or email to FastTrackOffice@uhbw.nhs.uk

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

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

Please attach images if you think these would assist secondary care triage - Tips for capturing imaging of oral lesions 

Dentists -  If patient meets the criteria for an USC referral please refer them directly by emailing the referral form to  FastTrackOffice@uhbw.nhs.uk

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

Risk Calculator

The following risk calculator can be used in primary care as part of the clinical assessment of patients with Head and Neck but not Oral MaxFax symptoms. The score from this can then be used to guide whether referral is required and if so with what level of urgency.

ORLHealth.com | HaNC-RC v2

Secondary Care Triage

All USC referrals will be triaged. Patients may be booked for a telephone assessment, for a diagnostic test or for an outpatients appointment.  

Referral Guidance

Suspected Head and Neck Cancer - General:

• 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 
• 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 - USC (2WW) pathway.

Patients with neck lumps meeting USC criteria should be referred via the USC pathway. Do not arrange a neck USS outside of this pathway. For neck lumps not meeting USC criteria, please see advice on the Ultrasound Guidance page.

Suspected Head and Neck Cancer – Ear, Nose and Throat Origin:

• Age >40 with constant unexplained hoarseness > 3 weeks, and a negative chest X-ray*
• Age >40 with an unexplained constant sore throat especially if severe or lateralising or associated with dysphagia, hoarseness or otalgia*
• Unexplained unilateral serous otitis media/ effusion in a patient aged over 18*

*Unilateral nasal obstruction with bloody discharge is usually a result of sinus disease, this is no longer an indication for an USC referral unless there are additional reasons for concern. Please refer this symptom for urgent (non cancer) assessment.

* Patients less than 40 with a hoarse voice or constant sore throat are very unlikely to have an underlying cancer, please refer these patients on a non-cancer pathway unless there are additional reasons for concern.

Other nasopharyngeal symptoms may require urgent referral; see nasal treatment section of Remedy for further details.

Suspected Thyroid Cancer:

• Unexplained thyroid lump 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:

If the patient has prompt access to dental assessment (within 2weeks) then NICE suggests that the following patients could be referred to a dentist outside of the USC pathway:

• a lump on the lip or in the oral cavity
• a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

If the patient doesn’t have access to a dentist then they can be referred on the USC pathway. If possible, please attach images of the area of concern to this referral.

Refer on USC pathway if

• Unexplained ulceration of the oral cavity or mass persisting for more than 3 weeks
• Unexplained red and white patches (including suspected lichen planus) of the oral cavity particularly if painful, bleeding or swollen and the patient doesn’t have prompt access to a dentist for assessment
• 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 (dental assessment advised initially if available)
• 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

Lymphadenopathy

Please also see the Lymphadenopathy (adults) page for further advice on assessment and management of lymphadenopathy if USC/2WW criteria are not met. 

Suspected Ophthalmological Malignancy

There is currently no formal Urgent Suspected Cancer (2WW) referral pathway for ophthalmology (Update October 2024 - this has been under review and we hope a dedicated pathway will be developed).

Suspected skin malignancy near the eye

Patients with suspected malignancy of the eyelid or near to the eye should be referred using the Skin USC pathway

Suspected intraocular or orbit malignancy

Patients with suspected ocular or orbit malignancy should be referred via eRS and marked urgent or discussed with the on call registrar if there are more immediate concerns.

Alternatively the Head and Neck USC pathway can be used. There is no tick box for ophthalmological malignancy on this form but concerns can be free texted and referrals should be accepted via this route.

Top tips in Head & Neck Cancer

1. A feeling of lump in throat is not a symptom of head and neck cancer.
2. Intermittent hoarse voice is not a symptom of head and neck cancer – it needs to be constant.
3. Tinnitus / blocked ears should never be referred on a 2 week wait.
4. An intra-oral lump that fluctuates in size is unlikely to be a cancer.
5. A soft, smooth surface, less than 1cm intra-oral lump is unlikely to be a cancer.
6. A lesion bilaterally intra-oral is unlikely to be a cancer.
7. Ulcers that come and go are not cancerous.

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.