Head and Neck Cancer including Thyroid Cancer

Services

Luton & Dunstable Hospital

Cancer Services

The Luton and Dunstable Hospital NHS Foundation Trust's Cancer Unit is part of the Mount Vernon Cancer Network.  The Network covers a geographical area from North London to mid-Bedfordshire, west to Buckinghamshire and east to Hertfordshire, providing services to a population of two million people.  The Mount Vernon Hospital Cancer Centre provides specialist care, including radiotherapy and complex chemotherapy, with the local Cancer Units and the Primary Care Trusts providing routine and on-going care, including chemotherapy.

Oncology services are provided by consultant staff from Mount Vernon, taking part in combined clinics with the Luton and Dunstable hospital staff.

To access the service please visit your GP.

The lead clinician for cancer services is Mr. Mike Pittam, Consultant Surgeon.

Multi-Disciplinary Team (MDT) meetings for all tumour sites are held on a regular basis, mostly weekly, to discuss newly diagnosed or suspected cancer patients.  Some MDT meetings participate in video-conferencing with other Network Teams to encourage wider discussion and input to the patient pathway.  The MDT Office can be contacted on either: 01582 718 268 or 01582 718 099.

HEAD AND NECK Clinics

  • ENT clinics - Paediatrics (5 days per week)
  • Oral & Maxillofacial Clinics (5 days per week)
  • Joint Head & Neck Oncology Clinic
  • Voice clinic
  • Rapid access neck lump clinic

Useful Numbers

Name, Telephone
Mr J Pickles 01582 497098
Miss J Panesar 01582 718078
Mr C Chan 01582 497333
Mr A Camilleri 01582 718247
Carole Glover [CNS] 01582 718038 bleep 498

SPECIALIST THYROID Clinics

  • Thyroid Thyroid (weekly)
  • One Stop clinic (monthly)
  • Ultrasound

Useful Numbers

Name, Telephone
Mr. Pittam 01582 497097
Mr D Ravichandran 01582 718009
Carole Glover [CNS] 01582 718038

Who to Refer

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 or 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 (within a few hours or even more quickly if necessary)

  • 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

Please note: when seeking/receiving advice in regard to patient care and making referrals, NHS Connecting for Health Information Governance standards and policies must be adhered to.

Resources

Map of Medicine Patient Pathway

Map of medicine - suspected head and neck cancer

Map of medicine - suspected thyroid cancer

NICE Guidelines

Website Resources

Cancer Network

Patient Information Leaflets

Patient information leaflet - Two Week Wait

Macmillan Cancer Support at the Luton & Dunstable Hospital



Last updated: 20/06/2013

Update due: 20/06/2014