Urgent referrals to see a specialist on the two-week-wait pathway (2WW) can be made for the following suspected cancers:

• brain and central nervous system
• breast
• children's
• gynaecology
• haematology
• head and neck
• lower gastrointestinal*
• lung and pleura
• ophthalmology
• sarcoma
• skin
• upper gastrointestinal
• urology.

*All patients with symptoms and signs suggestive of possible colorectal cancer should have a faecal immunochemical test (FIT) before referral unless they have a rectal or anal mass or anal ulceration. Read the changes to the LGI 2WW pathway. See Downloads for guidance on how to order/reorder FIT kits. 

For more information about cancer referrals, see the Pan-London suspected cancer referral support guide. 

It is important for practices to have a robust safety netting system. For information about the EMIS Macmillian safety netting template, see the EMIS user guide.

Visit the NCL Cancer Alliance website for details of the Your cancer pathway support guide, which offers comprehensive support for patients who are referred on a suspected cancer pathway or who have been diagnosed with cancer.

FIT<10 secondary care clinical pathway

Following national guidance and in collaboration with NCL providers, NCL Cancer Alliance has developed pathways within the colorectal services to move patients who have appropriate symptoms from the 2WW pathway to the NCL FIT<10 secondary care pathway. 

If a patient is referred on the colorectal 2WW pathway and they have a FIT<10 but do not have a rectal/anal mass or iron deficiency anaemia, following a clinical consultation with the patient with no alarming symptoms, they may be moved to the FIT<10 pathway for follow up.

PSA testing update

NCL urology services have requested that, from March 2023, if a GP suspects a patient has prostate cancer, they first request a prostate-specific antigen (PSA) test. If the result is elevated and a urinary tract infection is excluded, the patient should then be referred on an urgent suspected cancer pathway. 

GPs are also encouraged to include any previous PSA results in the referral, as PSA trajectory is useful clinical information. 

If the patient has an abnormal prostate on a direct rectal exam (DRE) they should be referred on a 2WW basis. GPs are also encouraged to perform and include a PSA test with the referral, even if it is normal.

If a PSA result is not included, some NCL trusts, such as University College London Hospitals (UCLH) and North Middlesex University Hospital (NMUH), will perform the PSA test, even with a report of an abnormal DRE. This delays access to a multiparametric MRI (MpMRI) until a result is available, and therefore bypassing the test in primary care will not hasten secondary care appointments. 

Finally, GPs should ensure that an estimated glomerular filtration rate (eGFR) result from the last three months is included. If a result is not readily available, a test should be organised prior to referral on the urgent suspected cancer pathway. Again, this allows services to offer a straight-to-test MpMRI.

The full pan-London guidance can be found on the Transformation Partners in Health and Care website.

How to Refer

Locations

Royal Free London

UCLH

Whittington Health

St Mary's

NMUH