Fast Track Referrals. Richard Sim Consultant ENT Surgeon. Background. ‘Referral guidelines for suspected cancer’ published by the Department of Health in 2000. NICE – updated 2005 www.nice.org.uk/CG027 http://nww.dorsetcancernetwork.nhs.uk/referral.htm. Timeline.
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Fast Track Referrals
Consultant ENT Surgeon
Palpable lymphadenopathy is common – 55% of children aged 6-12/12 and 41% of children aged 2-5 years.
Palpable liver or spleen
Larger size and progressive (>3cm)
However - Majority of nodes will be benign
Consider USS - most useful non-invasive?
Viral titres – may help in 10% of cases
If investigations unhelpful and nodes persistent or enlarging - consider need for excision biopsy.
Common – Palpable nodules in 5% of women and 1% of men worldwide.
Ultrasound can detect nodules in 19-67% of randomly selected individuals – more common in women and the elderly.
How do we select for further investigation / treatment?
Differentiated Thyroid cancer – 90%.
Incidence of papillary thyroid cancer increasing – 49% of increase <1cm and 87% <2cm.
Due to increased detection and early diagnosis with USS?
Thy1 – Repeat – USS guidance.
Thy2 – Consider interval USS and repeat.
Thy3a – MDT - Repeat biopsy / surgery
Thy3f – MDT - Surgery
Thy4 – MDT - Surgery
Thy5 – MDT - Surgery