Suspected Head and Neck Cancers Pathways
NICE guideline [NG12] Suspected cancer: recognition and referral. Last updated: Apr 2025.
Background Information
Suspected Cancer Pathway Referral
Historically, if a GP suspected cancer, the patient would be referred under the 2-week wait (2WW) pathway:
- Patient should be seen by a specialist within 2 weeks
- But no time limit was set for diagnoses or treatment
Since October 2021, NHS England has replaced the 2WW target with the 28-day Faster Diagnosis Standard (FDS):
- "Patients who are referred with suspected cancer should be diagnosed (cancer or not) within 28 days of referral."
Laryngeal Cancer
Recognition and Referral
Consider a suspected cancer pathway referral in:
- ≥45 y/o, AND
- Persistent unexplained hoarseness OR unexplained neck lump
Oral Cancer
Recognition and Referral
Consider a suspected cancer pathway referral if:
- Unexplained oral ulceration for >3 weeks, OR
- Persistent unexplained lump in the neck
Consider urgent referral (within 2 weeks) to dentist if:
- Lump on the lip or in the oral cavity
- Red (erythroplakia) or red and white patch (erythroleukoplakia)
If the dentist identifies a lump consistent with oral cancer / erythroplakia / erythroleukoplaia → consider suspected cancer pathway referral.
Thyroid Cancer
Recognition and Referral
Consider a suspected cancer pathway referral if:
- Unexplained thyroid lump