Head and Neck Cancers

Referral route  

Urgent suspected cancer (“2ww”) head and neck referrals are managed on e-RS by a ‘Referral Assessment Service (RAS)’.  This means appointment bookings cannot be made by the referrer and will ' defer to provider'.  Please refer into Urgent Suspected Cancer - Head & Neck RAS - Main Outpatients Department. We will then triage your referral and book the patient into one of our services:

• 2ww  Ear nose and throat (ENT)
• 2ww Oral  Maxillo  Facial (OMF)
• 2ww  Thyroid

GPs  should complete the Pan-London Urgent Suspected Cancer form in full, using the  current version. Current versions are found here: NHS England — London » Urgent Cancer Referrals. They should then upload the referral via eRS.nhs.uk . If possible, please also include a clinical photo  for suspected oral maxillofacial cancers.      

Dentists who do not have access to e-RS can complete the Pan-London-Urgent-Suspected-Head-and-Neck-Cancer-Referral-Form-Dental-2.docx and email this to huh-tr.Cancerreferrals@nhs.net along  with clinical photos of the lesion . Please use this referral pathway for any  suspicious neck lumps that you see for patients. You can  refer directly to us  rather than referring your patient back to their GP to make a referral.     

For routine Oral Maxillofacial referral pathways, please check here Oral maxillo-facial, head and neck surgery | Homerton.   

We usually arrange a telephone consultation if:  

• we're requesting investigations
• there are queries
• patient has complex needs.   

Ideally, patients will be invited to have their investigations prior to an outpatient appointment.  

The thyroid clinic mainly runs on Tuesday mornings. For endocrinology conditions, please refer to our Endocrinology Service. 

Possible procedures on typical USC (“2ww”) pathway  

• Ear nose and throat (ENT)  -  FNE nose, pharynx or larynx, CT and MRI. Micro Laryngoscopy Biopsy (MLB) may happen after clinical examination.  Gastroscopy.
• Oral Maxillofacial (OMF)  -  Ultrasound, FNA (fine needle aspiration),  nasoendoscopy , Core and open diagnostic biopsies.
• Thyroid  -  Comprehensive investigations including Ultrasound, FNA if  indicated , sometimes bloods, thyroid tests  

Essential tests prior to referral  

• Ear nose and throat (ENT) - FBC, U+E, GFR  
• Oral Maxillofacial (OMF) - FBC, U+E, GFR  
• Thyroid  -  Thyroid lump - thyroid function test + thyroid antibodies. See https://gps.cityandhackneyccg.nhs.uk/pathways/thyroid-ultrasound-pathway

Optional tests (concurrent to referral) or other useful information  

For thyroid referrals, a recent vitamin D test would be helpful.  

Things the hospital or patient need to know  

Any contraindications for MRIs (e.g. pacemakers, aneurism clips etc), claustrophobia, pregnancy, allergy to contrast. Please advise is patient  requires  an interpreter or has special needs. If patient  requires  transport, please support patient to book hospital transport.  

For thyroid, if ultrasound or thyroid function test has been done in the last six months, please attach results to the referral  

What the hospital tells the patient in letters  

Phone appointment letters  

We will try our best to call you on time. Please allow  one hour  from your appointment time for this call. Keep your phone free and nearby you during this time. Do make sure your phone can receive calls from private or withheld numbers. (You can check this with your telephone provider). Try to stay in a quiet place during the call. Your telephone appointment may be with a nurse or a doctor.   

Outpatient appointments  

We try hard to minimise delays in clinic, but you should allow up to  2 hours  for your appointment. You may  be required  to have some tests when you attend the clinic. You may be asked to have tests before your appointment. If so, someone will  get in touch with  the details. Please make sure you have these tests before your appointment if we ask you to do these.