
Contents
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1.1 Overview 1.1 Overview
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Introduction Introduction
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1.2 Lung cancer 1.2 Lung cancer
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Indications for suspected cancer pathway referral Indications for suspected cancer pathway referral
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Indications for urgent referral Indications for urgent referral
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1.3 Mesothelioma 1.3 Mesothelioma
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Indications for urgent referral Indications for urgent referral
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1.4 Breast cancer 1.4 Breast cancer
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Indications for urgent referral Indications for urgent referral
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Indications for non-urgent referral Indications for non-urgent referral
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1.5 Urological cancer 1.5 Urological cancer
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Warning features Warning features
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Indication for emergency referral Indication for emergency referral
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Indications for urgent referral Indications for urgent referral
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Renal and urinary bladder cancer Renal and urinary bladder cancer
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Prostate cancer Prostate cancer
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Testicular cancer Testicular cancer
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Penile cancer Penile cancer
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1.6 Nervous system tumours 1.6 Nervous system tumours
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Warning signs of brain tumours Warning signs of brain tumours
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Direct referral to an oncologist Direct referral to an oncologist
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Indications for urgent referral Indications for urgent referral
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Warning features of spinal cord compression Warning features of spinal cord compression
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1.7 Upper gastrointestinal cancer 1.7 Upper gastrointestinal cancer
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Indications for urgent referral Indications for urgent referral
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Indications for non-urgent referral Indications for non-urgent referral
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1.8 Lower gastrointestinal cancer 1.8 Lower gastrointestinal cancer
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Indications for urgent referral Indications for urgent referral
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Indications for non-urgent referral Indications for non-urgent referral
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1.9 Gynaecological cancer 1.9 Gynaecological cancer
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Indications for urgent referral Indications for urgent referral
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Indications for investigation in primary care Indications for investigation in primary care
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Tests for ovarian cancer Tests for ovarian cancer
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Indication for emergency referral Indication for emergency referral
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1.10 Haematological cancer 1.10 Haematological cancer
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Warning features Warning features
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Indications for very urgent referral Indications for very urgent referral
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Leukaemia Leukaemia
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Lymphoma in children and young adults Lymphoma in children and young adults
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Myeloma Myeloma
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Indications for urgent referral Indications for urgent referral
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Lymphoma in adults Lymphoma in adults
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Myeloma Myeloma
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1.11 Head and neck cancer 1.11 Head and neck cancer
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Indication for emergency referral Indication for emergency referral
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Indications for urgent referral Indications for urgent referral
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Laryngeal cancer Laryngeal cancer
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Oral cancer Oral cancer
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1.12 Thyroid cancer 1.12 Thyroid cancer
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Indication for emergency referral Indication for emergency referral
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Indications for urgent referral Indications for urgent referral
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1.13 Bone cancer and sarcoma 1.13 Bone cancer and sarcoma
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Indications for very urgent referral Indications for very urgent referral
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Indications for urgent X-ray/ultrasound Indications for urgent X-ray/ultrasound
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Indications for urgent referral Indications for urgent referral
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1.14 Skin cancer—melanoma 1.14 Skin cancer—melanoma
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Warning features Warning features
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Indications for urgent referral Indications for urgent referral
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1.15 Skin cancer—non-melanoma 1.15 Skin cancer—non-melanoma
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Indications for urgent referral Indications for urgent referral
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Indication for non-urgent referral Indication for non-urgent referral
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1.16 Further reading and internet resources 1.16 Further reading and internet resources
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Further reading Further reading
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Internet resources Internet resources
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Cite
Abstract
This chapter covers the clinical approach to suspected cancer, outlining warning features and indications for urgent and non-urgent referral according to the National Institute of Health and Care Excellence (NICE) recently updated 2005 guidance on referral for suspected cancer (NICE 2015). This guideline provides evidence-based indications for urgent referral from primary to secondary care for further investigations within two weeks of a suspected cancer. It also highlights a number of clinical situations where a very urgent (within 48 hours) or immediate referral (within a few hours) are needed. Indications for the cancer pathway and urgent referrals for various cancers are covered in this chapter. Topics include lung cancer, mesothelioma, breast cancer, urological cancer, nervous system tumours, upper and lower GI cancers, gynaecological cancer, haematological cancer, head and neck cancer, thyroid cancer, bone cancer and sarcoma, and skin cancer (melanoma and non-melanoma).
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