North Trent Cancer Network. Referral Guidelines, Head & Neck Cancer (including Thyroid), for Primary Care Practitioners

Transcription

1 North Trent Cancer Network Fulwood House Sheffield S10 3TH Tel: Fax: Referral Guidelines, Head & Neck Cancer (including Thyroid), for Primary Care Practitioners 1

2 Introduction The NICE Referral guidelines for suspected cancer have been agreed and adopted as the Network Referral Guidelines. These guidelines in conjunction with Two-Week Wait referral Forms for Patients with Suspected Cancer, and the Cancer Services Directories, together these documents should provide Primary Care Practitioners with the necessary information regarding named local services, contact points and process of referral. The primary care practitioner should, on the basis of clinical examination and history, consider the following key facts: Does the patient have features suggestive of Head & Neck or Thyroid Cancer Does the patient have a neck lump? Is the lump clinically a thyroid lump? Are there other features of urgency about the lump? Are there other urgent features which might suggest Upper Aerodigestive Tract ( UAT) or Haematological malignancy? Does the patient have stridor? If there is no neck lump does the patient have features suggesting malignancy? The following paragraphs deal with the actions to be taken by referring practitioner 2

3 Primary Care Referral Thyroid see Figure 1 Patients with a thyroid lump and severe stridor should be referred immediately (same day) to secondary care (A+E or telephone referral to the local designated thyroid surgeon). Patients with a thyroid lump and risk factors/suspicious features of thyroid cancer should be referred urgently (2ww) to a designated Thyroid lump clinic, See guidance below. Patients without risk factors/suspicious features should be referred nonurgently to a designated Thyroid lump clinic (Network target 4ww). Thyroid function tests should be performed in all patients and the result forwarded, but initiation of other investigations by the primary care physician (particularly ultrasound scanning) is unnecessary, may cause delay in making a diagnosis of cancer, and is discouraged. Patients with thyroid swelling and abnormal thyroid function should be referred routinely to an Endocrinologist. For further information, see Section 1 of Thyroid subsection of Network Guidelines for Referral and Treatment of H+N/Thyroid Cancer. 3

4 Figure 1:Primary Care Referral - Thyroid NECK LUMP? THYROID? STRIDOR? RISK FACTORS OR FEATURES SUSPICIOUS OF MALIGNANCY? REFERRAL GUIDELINE Clinically thyroid Severe Stridor Present Same day referral Designated Thyroid clinician or A&E NECK LUMP PRESENT No Stridor Thyroid mass rapidly enlarging over weeks Cervical lymphadenopathy Hoarseness/Voice change Age >55 Fast-track appointment Designated clinician for thyroid. Neck lump or thyroid Clinically non- thyroid SEE Figure 2 (page 10) Child/Adolescent Fast-track appointment Sheffield Children s Hospital (Children and Young Person s referral 4 No features suspicious of thyroid cancer Routine appointment Designated clinician for thyroid Neck lump or thyroid clinic

5 Primary Care Referral -Thyroid: List of Designated Clinics Barnsley Hospitals NHS FT A+E Contact Number (stridor) Designated Thyroid Clinician(s) Mr M H Wickham Contact Number of designated Secretary Via switchboard (fax) (phone) Via Choose & Book Bassetlaw DGH A+E Contact Number (stridor) Designated Thyroid Clinician(s) Contact Number of designated Chesterfield Royal Hospital NHS FT A+E Contact Number (stridor) Designated Thyroid Clinician(s) Mr DR Chadwick Contact Number of designated or bleep via Secretary: New Appointments: Mail (Red Envelope) or Fax: Choose and Book Clinic Codes (2ww): NLDC DRCG1 New Appointments by Mail Choose and Book Clinic Codes (routine): DRCG1 5

6 Primary Care Referral -Thyroid: List of Designated Clinics Doncaster Royal Infirmary A+E Contact Number (stridor) Designated Thyroid Clinician(s) Contact Number of designated Secretaries Mr Quraishi Ext 3642 Mr Watson Rotherham Hospital NHS FT A+E Contact Number (stridor) Designated Thyroid Clinician(s) Mr S Richards Contact Number of designated Secretary (phone) (fax) Via Choose & Book Sheffield Teaching Hospitals A+E Contact Number (stridor) Designated Thyroid Clinician(s) Mr B Harrison Mr S Balasubramanian Mr Allahabadia Contact Number of designated thyroid Secretaries: Mr Harrison/Balasubramanian Mr Allahabadia ( phone) (fax) (phone) (fax) 6

7 Primary Care Referral NECK LUMP/ NON THYROID -See Figure 2 Neck Lump /Clinically Non-thyroid - Where the lump persists for more than three weeks and there are no other features of malignancy patient should be referred as a fast track appointment to the designated clinician: Lump is non - thyroid and has other symptoms of head and neck malignancy plus stridor If the patient has stridor then it is essential to refer immediately (same day). Referral must be to the designated hospitals via A&E or to the designated clinician Lump is non - thyroid and has other symptoms of head and neck malignancy but no stridor If the patient has a neck lump that is clinically a Upper Aerodigestive Tract lump and has features suggestive of malignancy but there is no stridor then the patient should be referred to the designated neck lump service. Lump is non - thyroid and has other symptoms of haematological malignancy plus stridor. If the patient has stridor then it is essential to refer immediately (same day). Referral must be to the designated hospitals either to A& E or to the designated clinician. Lump is non - thyroid and has other symptoms of haematological malignancy but no stridor The patient should be referred either to Haematological Services or to the Neck Lump Clinic for joint discussion. 7

8 Primary Care Referral - NECK LUMP/ NON THYROID Figure 2-Designated Clinics Primary Care Referral - No NECK LUMP - Figure 3-Designated Clinics Barnsley Hospitals NHSFT A+E Contact Number (stridor) Designated Clinician(s) Mr M Wickham Mr M Nussbaumer Mr A Smith Contact Number of designated Secretaries: Mr Wickham Mr M Nussbaumer Mr A Smith ( via switchboard) (fax) (phone) Bassetlaw DGH Contact Doncaster ENT on call (stridor) Designated Clinician(s) Contact Number of designated (DRI) Chesterfield Royal Hospital NHSFT A+E Contact Number (stridor) Designated Clinician(s) Mr Orr Mr Doyle Mr Haneefa Contact Number of designated or bleep via Secretaries: Mr Orr/Doyle Mr Haneefa New Appointments: Mail (Red Envelope) or Fax: Choose and Book Clinic Codes (2ww): NLDC RLONP PTDNP New Appointments by Mail Choose and Book Clinic Codes (routine): RLOMN/PTDMN RLONP/PTDNP 8

9 Primary Care Referral - NECK LUMP/ NON THYROID Figure 2-Designated Clinics Primary Care Referral - No NECK LUMP - Figure 3-Designated Clinics Doncaster Royal Infirmary ENT on call Contact Number (stridor) Designated Clinician(s) Contact Number of designated Ext Rotherham Hospital NHSFT A+E Contact Number (stridor) Designated Clinician(s) Mr A Patterson Mr S Richards Contact Number of designated Mr Patterson Mr Richards (phone) (fax) Via Choose & Book Sheffield Teaching Hospitals ENT on call- (stridor) Designated ENT Clinician(s) Contact Number of designated ENT Designated OMFS Clinician(s) Contact Number of designated OMFS Contact ENT on call Mr T Westin Mr A Parker Secretaries :- Mr Westin Mr Parker Mr A Smith Mr S Ward Mr A Yousefpour Secretaries: - Mr Smith Mr Ward Mr Yousefpour ENT / (phone) ( fax) OMFS / (phone) (fax) Central Appts (phone) (phone) (fax) 9

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11 Figure 2: Primary Care Referral - Neck Lump non-thyroid NECK LUMP? THYROID? FEATURES SUSPICIOUS OF MALIGNANCY? STRIDOR? REFERRAL GUIDELINE SEE Figure 1 (page 4) Lump persists after 3 weeks No other features of malignancy Fast track appointment Designated clinician for UAT Neck Lump clinic Clinically thyroid Lump with other features of malignancy +/- stridor No Stridor Fast-track appointment Designated clinician for UAT Direct or at neck lump clinic NECK LUMP Clinically non- thyroid lump Lump with other features of haematological malignancy +/- stridor Stridor Same day referral to ENT on call Designated clinician Management then diagnosis Lump disappears within 3 weeks. No associated features of malignancy No Stridor Fast track appointment Cons, Haem-Oncology Direct or at neck lump clinic Not applicable Routine referral 11

12 Primary Care Referral NO NECK LUMP - See Figure 3 (page 12) No neck lump but features suggestive of malignancy and stridor The patient should be referred as an emergency as outlined in above No neck lump but features suggestive of malignancy but no stridor. If the patient has no neck lump but has features of Upper Aerodigestive Tract malignancy they should be referred on usual referral documentation/ proforma as Two Week Wait referral No neck lump no urgent features Should be referred in usual routine manner All organisations within the network are progressing towards full implementation of Choose & Book until full implementation is achieved, referrals will be made to the acute trusts via a standard referral letter or fax. 12

13 Figure 3: Primary Care Referral - No Neck Lump NECK LUMP FEATURES SUSPICIOUS OF MALIGNANCY? STRIDOR? REFERRAL GUIDELINE No NECK LUMP Features suspicious of UAT malignancy but no neck lump +orstridor -Hoarseness for >3 weeks - Oral mucosa ulcer > 3 weeks - Persistent swelling of the submandibular or parotid gland - Persistent sore or painful throat -Unilateral pain in head or neck for more than 4 weeks - Stridor and increasing dysphagia - Unilateral nasal obstruction - Unilateral nasal discharge in the over 50 - Unilateral persistent otitis media in over 50 - Orbital masses No Stridor Stridor Fast-track appointment 2WW Designated clinician for UAT Same day referral Designated clinician or A&E Management then diagnosis Patient has non-urgent UAT symptoms and no lump Routine appointment Central contact point of designated hospital referral 13