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You are here: Home / Resources / SystmOne Resource Centre / SystmOne Specialties / Cancer Overview / Suspected Cancer

Suspected Cancer

The CDRC Suspected Cancer decision support module is designed to help clinicians identify patients who might have cancer and to make the referral process as simple and efficient as possible. 

The system is based on the NICE guidance for Suspected Cancer.

The referral management system is designed specifically for practices in the North East of England but could be adapted for other areas. 

Suspected Cancer Referral Template

How to Access

In the lower left hand corner use the search bar, type in ‘Suspected Cancer Referral CDRC’ and select the following template:

Alternatively, press F12 and search for ‘Suspected Cancer Referral CDRC’, this will return the aforementioned template.

Suspected Cancer Referral Home Page

The Home page provides links to further information based on Cancer Sites and other clinical findings. This is arranged in the same groupings as the NICE guideline. 

Suspected Cancer Referral CDRC 
Brain CNS 
area st 
Co m bin ed County Durham. and 
Gastrointestnal (Combined 
Tees 
logy 
He a ONecK 
SNSS Serious norpso•ecihc symvtoms

Suspected Cancer Referral Cancer Sites

Each cancer site has a specific tab which includes the following:  

  • Referral criteria (based on NICE and tailored to your region) 
  • Referral protocols
  • Relevant clinical information e.g., blood results visible within the template 
  • Up-to-date relevant 2WW referral form (tailored to your region) 
  • Choose & Book referral link 
  • Cancer Patient Information Leaflet (PIL) link 
  • Coding for referral and cancer safety netting  

The following cancer sites are covered in the Suspected Cancer module, expand each cancer site node to view the displayed information: 

Brain & CNS
Brain & CNS 
Consider w (CT wit' if containdicmed) within 2 weeks adults with: 
• loss or 
• unilateral weakness. 
• cognitive dementia or mood 
• New focal seiures (with ormthout secondary ONSET epilepsy Clinic is alternative 
1m Result 
Suggests blain metastasis 
CNS metastases - "rims *noun 
CNS metastases 
• "mission if unstaöle 
Check 1m 
to MOT using "IOW 
URGENT to the o«na 
URGENT T"ussion —osu 
VUO 
NO last 1 
record Mitten
Breast
Breast 
Urgent (Male and Female) 
unexplained breast lump 
unexplained axillary lump 
with unilateral nipple symptoms 
• discharge 
• retraction 
• other changes 
• skin changes suggesting breast cancer 
2ww Sreast Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral for breast cancer 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
Non urgent (Male and Female) 
• <30y consider referral for unexplained breast lump 
use the referral form below marking it 'non-urgent' 
All Referrals
Gastrointestinal (combined) 
Gastrointestinal ( Combined ) 
GI Combined Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
1 Aug 2017 0'E- weight (22k) 
06 Dec 2018 0'E- weight (22A 
Quantitative faecal immunochemical test 
110 Kg (17 s. 
112 Kg (17s 
No numeric rex 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No numm 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
Z 
CDRC Gl Endoscopyview has no data for patient 
Expand 
Expand 
< FacResuts 
Iron Resuts 
<Siochem 
Expand 
All Referrals
Gynaecology
Gynaecology 
Problem 
Lesions suspicious of cancer of cervix or vagina 
Post-coital bleeding >35y, -4 weeks 
unexplained vulval lump/ulceration/bleeding 
Pelvic mass 
cal 25 -35 AND 
Abnormal USS OR 
ymptoms of ovarian cancer 
Post menopausal bleeding (more than 12m after menses stopped) 
unexpected vaginal bleeding >4wlF 
On tamoxifen OR 
After stopping HRT 
2ww Gynae Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral for gynae cancer 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
Other tests 
Triple swabs first to rule out infection 
Check Cal 25 (dont wait for result before referral) 
All Referrals
Haematology
Haematology 
Immediate Telephone Referral 
• F8C reported as acute leukaemia 
• Suspected cord compression or renal failure due to myeloma 
Fast Track 2ww Referral 
• unexplained splenomegaly 
• unexplained lymphadenopathy >2cm -6 weeks (check HIV, consider EBV/CMV) 
• Electrophoresis / light chain suggests myeloma 
• Bone xray suggests myeloma 
2ww Haematology Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral for haematology malignancy 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
Haemo lobin concentration 
Total white blood count 
Platelet count- observation 
E hroc e sedimentation rate 
Serum creatinine level 
CDRC CXR (last) view has no data for patient 
No numeric rea 
No numeric rea 
No numeric rea 
No numeric rea 
No numeric rea 
Fac Resuts 
Expand 
All Referrals
Head / Neck
Head I Neck 
ENT 
• with persistent unexplained hoarseness 
• Persistent unexplained neck or panoid lump of recent onset 
• Persistent unexplained unilateral enlargement/ ulceration oftonsil or soft palate 
Oral and Maxillofacial 
• unexplained ulceration or lump on lips or oral cavity -3 weeks 
• Persistent unexplained neck or panoid lump of recent onset 
• New unexplained red or redtwhite patch in the oral cavity *weeks but <6months 
Consider urgent referral (not 2ww) - do not use 2ww form 
• Persistent upper dysphagia (may be triaged to 2VWd if associated with pain on swallowing, and/or pain radiating to the same side ear, and weight loss - please give this 
information in the reason for referral 
• unexplained persistent sore throat 
• unexplained unilateral nasal obstruction when associated with blood-stained discharge and/or unilateral facial swelling 
• Delayed and unexplained non-healing of a dental extraction socket for over 3 weeks 
2ww Head 8 Neck Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral - head and neck cancer 
Provision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
All Referrals
Lower GI
(Colorectal) 
Practices in County Durham, Darlington and Tees Valley should use the combined Gl pathway 
• Addominal, rectal, anal mass/ulceration 
• FIT positive 
• Age unexplained weight loss AND abdominal pain (check Cal 25) 
• Rectal bleeding AND abdo pain / change in bowel habit/ IDA 
• Rectal bleeding 
• Iron deficiency anaemia if: 
• Male 
• non menstruating 
Other specific concern of coloretal cancer 
Combined P 
2ww LGI Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral for lower GI cancer 
Provision of information about cancer 
Cancer safety netting 
Quantitative faecal immunochemical test 
Wizard 
Other formats 
No numeric rea 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No numm 
Z 
Fac Resuts 
Iron Resuts 
<Siochem 
All Referrals
Lung
Lung 
Urgent Telephone Advice 
• Signs of SVC obstruction 
• Stridor 
CXR (urgent) if >=40y 
ofthese symptoms ifsmoker or asbestos exposure) 
• Cough 
• Chest pain 
• Fatigue 
Weight loss 
soa 
• Anorexia 
Fast track (2ww) Referral 
• unexplained haemoptysis > 
• CXR suspicous for lung cancer 
• Normal CXR but high suspicion of lung cancer 
• Any of: 
• Persistent/recurrent LRTI 
• Clubbing 
• Thrombocytosis 
• Neck or supraclavic LN 
• Asbestos exposure and recent chest pain OR SOB OR systemic upset OR suspicious CXR 
2ww Vang Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral for lung cancer 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
1 Aug 2017 
06 Dec 2018 
O/E - weight (22A 
O/E - weight (22A 
110 Kg (17 
112 Kg (17s 
No nunm 
No nunm 
nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No numm 
Expand 
< E pand 
- Fac Resuts 
<Siochem 
All Referrals
Malignancy of Unknown Origin (MUO) 
Malignancy of Unknown Origin 
t 2'"vVVMU0 Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No nunm 
No numm 
No nunm 
- Fac Resuts 
Iron Resuts 
<Siochem 
All Referrals
Sarcoma 
Sarcoma 
BONE PAIN 
Patients with undiagnosed bony pain should receive an x-ray Ifthe x-ray is normal but pain persists, consider following up and repeating the x-ray, performing bone function tests 
or making a non-urgent referral 
SOFT TISSUE MASS 
Request an urgent USS to be performed and reported within 2 weeks for people with an unexplained lump increasing in size (note guidance for head and neck lumps - refer to 
head and neck clinic) 
Lumps are more suspicious of sarcoma ifthey are: >5cm diameter, painful, increasing in size, deep to fascia, fixed 
RECURRENCE 
Ifthere is a suspected recurrence of sarcoma following previous excision - please refer direct to 2VWd sarcoma - Do Not wait for USS 
2ww Sarcoma Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral for sarcoma 
Provision of information about cancer 
Cancer safety netting 
Wizard 
Other formats 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No nunm 
No numm 
- Fac Resuts 
<Siochem 
All Referrals
Serious Non-Specific (SNS) 
Serious Non-Specific 
Local Referral Crteriaffests 
t 2ww SNS Referrai Form 
e-ReferraI Ser vice Referral 
2ww Cancer PIL 
New Task 
Expand 
Fast track cancer referral 
Provision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
9 
9 
9 
auantitative faecal immunochemical test 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No num_ 
No nuny 
No nunm 
No numeric reac[ 
Z 
07 Au 2015 Urine blood test=ne ative 46g2 
Fac Resutts 
Iron Resutts 
Giochem 
AII Referrais
Skin
Skin 
Biopsy confirmed melanoma - Ring skin cancer nurse specilaist to arrange urgent appointment 
Suspected Melanoma or SCC - 2ww Fast track referral 
NO clear record of FHx of melanoma 
Plastics referral if: 
• Nose lips eyes ears 
• Needs hoist 
• >20mm scalp or lower leg 
• Likely to need GA eg dementia / LD 
• -I Smm on body 
• -I Omm on face 
Otherwise refer to dermatology 
Suspected BCC 
Plastics referral if: 
• Nose lips eyes ears 
• >20mm scalp 
• -I Omm neck and above 
Routine Dermatology Referral 
• Needs hoist 
• Likely to need GA eg dementia / LD 
Otherwise refer to dermatology 
Information for Referral 
• Take 3 photographs - close up, at 20cm and dermoscopy 
• Can the patient use the telephone? 
Previous skin cancer and treatment - see box > 
Immunsuppression - see box > 
Family history of malignant melanoma 
t Skin Referral Checklist 
2ww Skin Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
New Task 
Fast track referral for skin cancer 
Provision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
All Referrals
Thyroid
Thyroid 
Fast Track 2ww Referral 
• Any solitary thyroid nodule 
• Rapid increase in size of a goitre or thyroid nodule 
• unexplained hoarseness in the presence of a goitre or thyroid nodule 
• Cervical lymphadenopathy in the presence of a goitre or thyroid nodule 
• Patient age -65 
• History of endocrine tumour 
• History of neck irradiation 
If hyper- or hypothyroid refer directly to endocrinology 
2ww Ihyroid Referral form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral head and neck cancer 
Provision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
All Referrals
Upper GI
UGI 
Practices in County Durham, Darlington and Tees Valley should use the combined Gl pathway 
Fast Track 2ww Referral 
with jaundice 
• upper abdominal mass 
• Abnormal CT/LISS suggesting OGI cancer 
• Dysphagia 
with weight loss AND upper abdo pain / reflux/ dyspepsia / nausea / vomiting 
2ww CT scan 
with weight loss AND diarrhoea / constipation / back pain / abdo pain / nausea / vomiting / new diabetes 
Consider non-urgent referral 
• Treatment resistant dyspepsia 
• upper abdominal pain and anaemia 
• Raised platelet count AND nausea / vomiting / weight loss / reflux/ dyspepsia / upper abdo pain 
• Nausea/vomiting AND reflux/ dyspepsia / upper abdo pain 
2ww LIGI Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
:ast track referral for LIGI cancer 
3rovision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
Combined P 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No num 
No numm 
- Fac Resuts 
All Referrals
Urology
Urology 
Fast track 2ww Referral 
Visible haematuria without LITI (Check PSA and DRE in men) 
Urine blood test: negative (46g2J 
Urine blood test: negative (46g2J 
Non-visible haematuria AND dysuria 
Non-visible haematuria AND raised WCC 
• Imaging suggests urinary tract mass 
• Suspicious testicular lump 
• Elevated or rising PSA 
• 50-5gy 
• 60-e,gy 
• 70-7gy 
WCC Not Recorded in last 1 month 
• Penile mass / ulceration OR persistent unexplained foreskin or glans symptoms 
Ensure IJ+E is present within the last 1 month 
2ww Urology Referral Form 
e-ReferraI Service Referral 
2ww Cancer PIL 
7 
New Task 
Fast track referral for urological cancer 
Provision of information about cancer 
Cancer safety netting 
Wzard 
Other formats 
22 dui 2015 
07 Aug 2015 
No numm 
No nunm 
No nunm 
No nunm 
No nunm 
- Fac Resuts 
< All PSAs 
<-Expand 
<Siochem 
All Referrals

Making a Referral

2ww Referral Proformas

The 2WW Referral Proformas are designed to extract all necessary information from the medical record to minimise the time needed to complete the form and maximise the utility of the form for secondary care.

Each Referral Proforma has a similar structure:

  • Reason for referral 
  • Recent consultations, relevant values and codes from the record 
    • Includes smoking, alcohol consumption, BP, drug abuse codes and codes to indicate the patient is at risk of harming others.   
  • Medical history, medication and adverse reactions: 
    • For problem based forms, all active problems and all major inactive problems 
    • For summary based forms all current and past significant summary entries 
    • Current repeats (excluding items such as sharps bins, dressings etc.) 
    • Information about dosette boxes 
    • Current acute medication 
    • All adverse reactions 
  • Patient demographics and key information 
    • Standard demographics, ethnicity and language 
    • All information about accessible information requirements e.g., vision and hearing problems, need for a translator 
    • Safeguarding information about adults and children 
    • Anaesthetic risk information 

Click on the form protection button on the Word toolbar and complete the shaded fields 

If you need to amend any of the information in the proforma turn form protection off and make the amendments. 

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