Bones - Palpable lump that is either:
- Greater than 5cm in diameter
- Deep to fascia, fixed or immobile
- Increasing in size
- Painful
- A recurrence after previous excision
- Xray suspicious of cancer
Neuro - Progressive development of:
- Limb weakness
- Visual impairment
- Ataxia
- Dysphasia
- Focal seizures with:
- Post-ictal deficit
- Progressive neurological signs
- Progressive recent headache with:
- History of specific malignancies within 10 years:
- New onset of:
- Non-migraine headache
- Epilepsy
Breast - Any age with a discrete, hard lump with fixation with or without skin tethering
- Discrete lump – Patient > 30 year persisting after next period or after menopause
- Breast skin distortion / ulceration / nodule
- New nipple retraction / distortion / eczema
- Spontaneous unilateral & / or Bloodstained nipple discharge
- Asymmetrical nodularity persisting after period in Patient > 30 years old
- Axillary lymphadenopathy
- Suspicion of recurrent breast cancer
Colorectal - Rectal bleeding with change of bowel habit of 6 weeks duration (age 40 and over)
- Rectal bleeding without change in bowel habit with no obvious cause 6 weeks duration (age 60 and over)
- Change of bowel habit persisting for 6 weeks or more without bleeding (age 60 years and over)
- Right Lower Abdominal mass consistent with involvement of large bowel (any age)
- Palpable rectal (not pelvic) mass (any age)
- Males of any age with Hb less than 110
- Non menstruating female with Hb less than 100
Gynae - Suspicion of cervical cancer
- Suspicion of Vulval cancer
- Postmenopausal bleeding in women with a uterus
- Suspicious bleeding on HRT
- Suspicious mass on pelvic ultrasound (multilocular or solid mass with or without ascites)
- IMB in women age after 45
Haematology - Persistent unexplained splenomagaly
- Immediate referral:
- Blood count/film reported as acute leukaemia
- Spinal cord compression or renal failure suspected cause myeloma
Head and neck - Unexplained lump in the neck, of recent onset
- Previously undiagnosed lump that has changed over a period of 3 to 6 weeks
- Unexplained persistent swelling in the parotid or submandibular gland
- Unexplained persistent sore or painful throat
- Unilateral unexplained pain in the neck and neck area for more than 4 weeks, associated with otalgia but a normal otoscopy
- Unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks
- Uexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful or swollen or bleeding
Lung - Smokers or ex-smokers >40 years with persistent haemoptysis
- Chest X-ray suggestive of lung cancer
- Normal chest X-ray where there is a high suspicion of lung cancer
Neuroblastoma - Child with:
- Proptosis
- Unexplained back pain
- Leg weakness
- Unexplained urinary retention
- Wilm’s tumour (all ages)
- Abdominal mass with persistent/progressive abdominal distention (immediate referral)
- Haematuria
- Suspicious symptoms unable to undertake abdominal examination
Skin - Pigmented skin lesion scoring 7 or more:
- Change in size (2)
- Irregular shape (2)
- Irregular colour (2)
- Largest diameter 7mm or more (1)
- Inflammation (1)
- Oozing (1)
- Change in sensation (1)
- Lesion suspected to be melanoma
- Non-healing keratinizing or crusted tumours larger than 1cm with significant induration on palpation
- Immunosuppressed patients with new or growing cutaneous lesions
- Histological diagnosis of squamous cell carcinoma
Soft tissue sarcoma - Unexplained mass with following features:
- Deep to fascia
- Non-tender
- Progressively enlarging
- Enlarging regional lymph node
- Mass greater than 2 cm
Thyroid - Thyroid swelling plus:
- Solitary nodule, typically hard, increasing in size
- Unexplained hoarsness/voice change
- Enlarged cervical nodes
- Family history of endocrine tumour
- History of neck radiation
- Aged 65+
- Prepubertal patients
Upper GI - Dysphagia
- Over 45 with:
- Unintentional weight loss with dyspepsia P
- Persistent vomiting/anorexia/ early satiety
- Iron deficiency anaemia and dyspeptic symptoms
- Painless obstructive jaundice
- Persistent new-onset dyspepsia (despite 1/12 therapy)
Urology - Prostate
- Hard, irregular prostate
- Rising/raised age-specific PSA with normal prostate
- Symptomatic with high PSA
- Bladder and renal
- Painless macroscopic haematuria without UTI
- Over 40 with persistent/recurrent urinary tract infection associated with macroscopic haematuria
- Clinical/imaged urinary tract mass
- Over 50 with unexplained microscopic haematuria on urine microscopy without infection
- Testicular
- Swelling/mass in body of testis
- Penile
- Symptoms/signs of penile cancer
Urgent OGD - Chronic gastrointestinal bleeding
- Progressive unintentional weight loss
- Dysphagia
- Persistent vomiting
- Iron deficiency anaemia
- Epigastric mass
- Suspicious barium meal
- Recent/Unexplained/Persistent symptoms in a patient over 55
Children under 16 - Leukaemia
- Unexplained petechiae
- Hepatosplenomegaly
- Lymphomas
- Hepatosplenomegaly
- Mediastinal or hilar mass on chest X-ray
- Unexplained shortness of breath and unexplained petechiae or hepatosplenomegaly
- 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
- Brain and CNS
- Reduced level of consciousness
- Headache and vomiting that cause early morning waking or occur on waking
- Children younger than 2 years with:
- New-onset seizures
- Bulging fontanelle
- Extensor attacks
- Persistent vomiting
- 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
- Neuroblastoma
- Children younger than 6 months with:
- Lump in the abdomen
- Small lumps on the skin
- Proptosis
- Unexplained back pain
- Leg weakness
- Unexplained urinary retention
- Wilm’s tumour
- Soft Tissue Sarcoma
- Unexplained mass at almost any site that has one or more of the following features:
- Deep to the fascia
- Non-tender
- Progressively enlarging
- Associated with a regional lymph node that is enlarging
- Greater than 2cm in diameter
- Bone Sarcoma (osteosarcoma and Ewing’s sarcoma)
- Persistent localised bone pain/swelling with X-ray showing signs of cancer
- Rest pain, back pain and unexplained limp
- Retinoblastoma
- White papillary reflex (leukocoria)
- Suspicious new squint or change in visual acuity if cancer is suspected
- Family history of retinoblastoma and visual problems
- General
- Presents several times with the same problem, but with no clear diagnosis
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