Oral Cancer Toolkit

Improve your ability to prevent and detect oral cancer

Referral

Discover the signs and symptoms that should prompt referral to secondary care via a suspected cancer pathway.

Click on the recommendations below to view the signs and symptoms that indicate urgent referral.

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:

  • unexplained ulceration in the oral cavity lasting for more than 3 weeks or
  • a persistent and unexplained lump in the neck

Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:

  • a lump on the lip or in the oral cavity or
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either:

  • a lump on the lip or in the oral cavity consistent with oral cancer or
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.

View the full NICE guidelines

Cancer Research UK statement on NICE guidance

Cancer Research UK recommends that both GPs and dentists should consider referring to secondary care for all oral cancer signs and symptoms featured in NICE guidance, without the need for cross referral from GPs to dentists for assessment of symptoms. The reasons for this are:

  • cross referral from GP to dentist introduces an additional step and potential delay into the diagnostic pathway for patients
  • many people do not have a dentist and dental practices won’t always have the capacity to take on new NHS patients 
  • visiting a dentist is associated with financial outlay, which can present a barrier for some patients
  • the extra step may confuse/ inhibit patients from attending further appointments

Consider an urgent suspicion of cancer referral for head and neck cancer in people with the following symptoms:

  • Persistent unexplained head and neck lumps >3 weeks
  • Ulceration or unexplained swelling of the oral mucosa persisting for >3 weeks
  • All red or mixed red and white patches of the oral mucosa persisting for >3 weeks
  • Persistent hoarseness lasting for >3 weeks (request a chest X-ray at the same time)
  • Dysphagia or odynophagia (pain on swallowing) lasting for >3 weeks
  • Persistent pain in the throat lasting for >3 weeks

Consider an urgent suspicion of cancer referral for thyroid cancer in people with the following symptoms:

  • Solitary nodule increasing in size
  • Thyroid swelling in a pre-pubertal patient
  • Thyroid swelling with one or more of the following risk factors:
    • neck irradiation
    • family history of endocrine tumour
    • unexplained hoarseness
    • cervical lymphadenopathy
View the Healthcare Improvement Scotland guidelines

The information given to people with suspected cancer and their families and/or carers should cover, among other issues:

  • where the person is being referred to
  • how long they will have to wait for the appointment
  • how to obtain further information about the type of cancer suspected or help before the specialist appointment
  • what to expect from the service the person will be attending
  • what type of tests may be carried out, and what will happen during diagnostic procedures
  • how long it will take to get a diagnosis or test results
  • whether they can take someone with them to the appointment
  • who to contact if they do not receive confirmation of an appointment
  • other sources of support
View the lesion recognition resource ›

References
  1. National Insititute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral [NG12]. June 2015. Available at: www.nice.org.uk. Accessed October 2017
  2. Healthcare Improvement Scotland. Scottish referral guidelines for suspected cancer. August 2014. Available at: www.healthcareimprovementscotland.org. Accessed October 2017
Acknowledgements

Cancer Research UK would like to acknowledge the following clinicians for their invaluable input into the development of the Oral Cancer Toolkit: Professor Richard Shaw, Professor Peter Brennan, Professor Saman Warnakulasuriya, Dr Afsana Safa, Mr Craig Wales, Professor Mark McGurk, Professor Crispian Scully, Dr Nigel Carter, Dr Bijay Rajlawat and Dr Caroline McCarthy.

Medical knowledge and the legislative framework are constantly changing. As new information becomes available changes in treatment, procedures, equipment and the use of drugs is necessary. The authors and editors have, as far as it is possible, taken care to ensure that the information given in this module is accurate and up to date at the time it was created. However, users are strongly advised to confirm that the information complies with current legislation and standards of practice.

Date of preparation: October 2018

Patient case studies

To learn more about diagnosing and referring oral cancer, read case studies from Richard Shaw, Professor of Head and Neck Surgery, University of Liverpool and Aintree University Hospital NHS Trust.

View case studies

Oral cancer risk factors

Some of the risk factors associated with oral cancer include:

  • age
  • tobacco use (smoking and chewing)
  • betel quid (areca nut) use
  • alcohol consumption
  • human papillomavirus infection

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