Head and Neck Cancer including Thyroid Cancer

Services

Bedford Hospital

Head and Neck including Thyroid Cancer Services

Head and Neck cancer services at Bedford Hospital are provided by the Head and Neck Team which consists of Consultants and Clinical Nurse Specialists. 

The Head and Neck Team

The Consultants and Clinical Nurse Specialists are:

Consultants
Mr S Patel 01234 355 122 ext:2894 Suresh.Patel@bedfordhospital.nhs.uk
Mr Hoare 01234 355122 ext:2850 Tim.Hoare@bedfordhospital.nhs.uk
Mr Arasaratnam 01234 355122 ext:2852 Royce.Arasaratnam@bedfordhospital.nhs.uk

Nurse
Ian Salmon 01234 355122 ext 2725 Ian.Salmon@bedfordhospital.nhs.uk

Outpatient Appointments

Following referral under the 2 week rule, patients will be seen in outpatients by a Consultant or another member of the team with 1-2 weeks.

Outpatient clinics take place:

Day Morning Afternoon
Monday - -
Tuesday Mr Arasaratnam Mr Hoare
Wednesday - -
Thursday - -
Friday Mr Patel (2nd and 4th week) -

 

Who to Refer

All patients can be referred; particularly those covered by the Anglia Cancer Network area - NHS Bedfordshire residents in North and East Bedfordshire.

Urgent Referral within 2 Weeks (under 2 week rule)

Refer urgently patients with:

  • An unexplained lump in the neck, of recent onset, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks.
  • An unexplained persistent swelling in the parotid or submandibular gland
  • An unexplained persistent sore of painful throat.
  • Unilateral unexplained pain in the head and neck area for more than 4 weeks, associated with otalgia (ear ache) but a normal otoscopy.
  • Unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks.
  • Unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful or swollen or bleeding.

For patients with persistent symptoms or signs related to the oral cavity in whom a definitive diagnosis of a benign lesion cannot be made, refer or follow-up until the symptoms and signs disappear.  If the symptoms and signs have not disappeared after 6 weeks, make an urgent referral.

Refer to a Dentist

  • Refer urgently to a dentist patients with unexplained tooth mobility persisting for more than 3 weeks.

Monitor for oral cancer patients confirmed oral lichen planus, as part of routine dental examination.

Advise all patients, including those with dentures, to have regular dental checkups.

Refer for a Chest X-ray

  • Refer urgently for chest X-ray patients with hoarseness persisting for more than 3 weeks, particularly smokers aged older than 50 years and heavy drinkers.

If there is a positive finding, refer urgently to a team specialising in the management of lung cancer.  If there is a negative finding refer urgently to a team specialising in head and neck cancer.

Non-urgent referral for Head and Neck

  • Refer non-urgently a patient with unexplained red and white patches of the oral mucosa that are not painful, swollen or bleeding (including suspected lichen planus).

Investigations

With the exception of persistent hoarseness, investigations are not recommended as they can delay referral

Thyroid Cancer

Immediate Referral (with a few hours or even more quickly if required)

  • Refer immediately patients with symptoms of tracheal compression including stridor due to thyroid swelling.

Urgent Referral within 2 Weeks (under 2 week rule)

Refer urgently patients with a thyroid swelling associated with any of the following:

  • A solitary nodule increasing in size.
  • A history of neck irradiation.
  • A family history of an endocrine tumour.
  • Unexplained hoarseness or voice changes.
  • Cervical lymphadenopathy.
  • Very young (pre-pubertal) patient.
  • Patient aged 65 years and older.

Investigations

  • Primary Care initiation of investigation such as ultrasonography or isotope scanning is not recommended.
  • Request thyroid function tests in patients with a thyroid swelling without stridor or any of the features listed above.  Refer patients with hyper- or hypothyroidism and an associated goitre, non-urgently, to an endocrinologist.  Patients with goitre and normal thyroid function tests without any of the features listed above should be referred non-urgently.

Macmillan Cancer Support Rapid Referral Guidelines

Macmillan Cancer Support Rapid Referral Guidelines

Who not to Refer

Patients outside of the Anglia Cancer Network area are usually referred to Hospitals within their Cancer Network area.  NHS Bedfordshire residents living in North and East Bedfordshire are included under the Anglia Cancer Network.

South Bedfordshire patients are included under the Mount Vernon Cancer Network and usually referred to the Luton & Dunstable Hospital NHS Foundation Trust.

Resources

Map of Medicine Patient Pathway

Map of Medicine Patient Pathway - suspected head and neck cancer
Map of Medicine Patient Pathway - suspected thyroid cancer

NICE Guidelines:

CG27 Referral for suspected cancer: full guideline
http://guidance.nice.org.uk/CG27/Guidance
CG27 Referral for suspected cancer: quick reference guide
http://guidance.nice.org.uk/CG27/QuickRefGuide/pdf/English
CG27 Referral for suspected cancer: information for the public
http://guidance.nice.org.uk/CG27/PublicInfo/pdf/English
CG27 Referral for suspected cancer: NICE guideline
http://guidance.nice.org.uk/CG27/NICEGuidance/pdf/English

Website Resources

Head & Neck Cancer  NHS Choices:
http://www.nhs.uk/conditions/cancer-of-the-head-and-neck/Pages/Definition.aspx
Cancer Research UK - Head & Neck Cancer:
http://cancerhelp.cancerresearchuk.org/type/head-and-neck-cancer/
Macmillan Cancer Support - Head & Neck Cancer
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Headneck/Headneckcancers.aspx
Thyroid Cancer NHS Choices:
http://www.nhs.uk/conditions/Cancer-of-the-thyroid/Pages/Introduction.aspx
The British Thyroid Foundation:
http://www.btf-thyroid.org/
Butterfly Thyroid Cancer Trust:
http://www.butterfly.org.uk/
Cancer Research UK - Thyroid Cancer:
http://cancerhelp.cancerresearchuk.org/type/thyroid-cancer/
Lab Tests Online:
http://www.labtestsonline.org.uk/understanding/analytes/thyroglobulin/tab/glance
Macmillan Cancer Support - Thyroid Cancer:
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Thyroid/Thyroidcancer.aspx

Cancer Network

Anglia Cancer Network - for residents from Norfolk, Suffolk, Bedfordshire and Cambridgeshire
http://www.angliacancernetwork.nhs.uk/



Last updated: 28/04/2014

Update due: 28/04/2015