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Head/neck cancer - suspected - Management
Specific recommendations
- An urgent referral should be made for a patient who presents with unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are:
- Painful, or
- Swollen, or
- Bleeding
- A non-urgent referral should be made in the absence of these features. If oral lichen planus is confirmed, the patient should be monitored for oral cancer as part of routine dental examination* (C).
- In patients with unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks, an urgent referral should be made (C).
- In adult patients with unexplained tooth mobility persisting for more than 3 weeks, an urgent referral to a dentist should be made (C).
- In any patient with hoarseness persisting for more than 3 weeks, particularly smokers 50 years of age and older and heavy drinkers, an urgent referral for a chest X-ray should be made. Patients with positive findings should be referred urgently to a team specialising in the management of lung cancer. Patients with a negative finding should be urgently referred to a team specialising in head and neck cancer (C).
- In patients with an unexplained lump in the neck which has recently appeared or a lump which has not been diagnosed before that has changed over a period of 3 to 6 weeks, an urgent referral should be made (C).
- In patients with an unexplained persistent swelling in the parotid or submandibular gland, an urgent referral should be made (D).
- In patients with unexplained persistent sore or painful throat, an urgent referral should be made (D).
- In patients with unilateral unexplained pain in the head and neck area for more than 4 weeks, associated with otalgia (ear ache) but with normal otoscopy, an urgent referral should be made (D).
*See NICE guideline on Dental recall: recall interval between routine dental examinations (www.nice.org.uk/CG019) [NICE, 2004].
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