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  Two-Week Wait Rule - Suspected Cancer  
     
 
Referral Guidelines for Suspected Cancer (Two week wait rule) based on NICE Guidance 2005
 
Last Updated October 2012.
 

Cancer in Children and Young People - Haematological Malignancies

Urgent Referral and Investigations

When a child or young person presents

  • Three or more times with the same problem, but no clear diagnosis

 

Immediate Referral

Refer immediately children or young people with either:

  • Unexplained petechiae
  • Hepatosplenomegaly or
  • Medistinal or hilar mass on chest X-ray

 

Urgent Referral

Refer urgently children or young people with one or more of the following (particularly if no evidence of local infection)

non-tender, firm or hard lymph nodes

lymph nodes greater than 2cm in size

lymph nodes progressively enlarging

other features of general ill health, fever or weight loss

axillary node involvement (in the absence of local infection or dermatitis)

supraclavicular node involvement

 

 

Cancer in Children and Young People - Brain and CNS Tumours

Immediate Referral

Refer immediatley, children or young people with

  • a reduced level of consciousness
  • headache and vomiting that cause early morning waking (classical signs of raised intrcranial pressure (ICP))

Refer immediately, children <2 years with any of the following symptoms

  • Bulging fontanelle
  • Extensor attacks
  • Persistent vomiting

 

Consider Immediate Referral

Refer urgently or immediately children with any of the following neurological symptoms and signs

  • New onset seizures
  • Cranial nerve abnormalities
  • Visual disturbances
  • Gait abnormalities
  • Motor or sensory signs
  • Unexplained deteriorating school performance or developmental milestones
  • Unexplained behaviour and / or mood changes

 

Urgent Referral

Children aged >2 years and young people with

  • a persistent headache where you cannot carry out an adequate neurological examination in primary care

Children aged <2 years with

  • abnormal increase in head size
  • arrest or regression of motor development
  • altered behaviour
  • abnormal eye movements
  • lack of visual following
  • poor feeding / failure to thrive
  • squint (urgency dependent on other factors)

 

Cancer in Children and Young People - Neuroblastoma

Urgent referral

Refer urgently children with

  • proptosis
  • unexplained back pain
  • leg weakness
  • unexplained urinary retention

 

 

Cancer in Children and Young People - Wilms' Tumour

Immediate referral

Refer immediately patients

  • with a painless abdominal mass

Urgent Referral

Refer urgently a child or young person

  • persisting with haematuria

 

Cancer in Children and Young People - Soft Tissue Sarcoma

Urgent Referral

Refer urgently a child or young person presenting with an unexplained mass at almost any site that has one or more of the following features. The mass is

  • deep to the fascia
  • non-tender
  • progressively enlarging
  • associated with a regional lymph node that is enlarging
  • greater than 2cm in diameter size

 

Cancer in Children and Young People - Bone Sarcomas (Osteosarcoma and Ewing's Sarcoma)

Referral

Refer children or young people with

  • pain at rest, back pain and unexplained limp (a discussion with a paediatrician or X-ray should be conisdered before or as well as referral)
  • persistent localised bone pain and / or swelling, and X-ray showing signs of cancer. In this case refer urgently

 

Cancer in Children and Young People - Retinoblastoma

Urgent Referral (mostly children <2 years)

Refer urgently, children with

  • a white pupillary reflex(leukocoria). Pay attention to parents reporting an odd appearance in their child's eye
  • a new squint or change in visual acuity only if cancer is suspected
  • a family history of retinoblastoma

 

 
 
 
     
   
   
   
 

 

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