Suspected Cancer Two-Week Referrals (2WW)

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Under Review — this page was due to be reviewed by Wednesday, 24 July 2024. The information shown here may be outdated.

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.

See Downloads for cancer patient pathway information leaflets and other supporting information.

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.

See Downloads for the pathway.

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

EMIS form

Referral methods: e-Referrals

Urgent referrals for suspected cancer should be sent using the appropriate referral forms:

  • Pan London Urgent Suspected Brain and CNS Cancer Referral Form
  • Pan London Urgent Suspected Breast Cancer Referral Form
  • Pan London Urgent Suspected Children's Cancer Referral Form
  • Pan London Urgent Suspected Gynaecology Cancer Referral Form
  • Pan London Urgent Suspected Haematological Cancer Referral Form
  • Pan London Urgent Suspected Head and Neck Cancer Referral Form
  • Pan London Urgent Suspected Lower GI Cancer Referral Form
  • Pan London Urgent Suspected Lung and Pleural Cancer Referral Form
  • Pan London Urgent Suspected Ophthalmology Cancer Referral Form
  • Pan London Urgent Suspected Sarcoma Referral Form
  • Pan London Urgent Suspected Skin Cancer Referral Form
  • Pan London Urgent Suspected Upper GI Cancer Referral Form
  • Pan London Urgent Suspected Urological Cancer Referral Form

Where to find the forms

  • Barnet: BAR Global Documents > 2WW Cancer Referral Forms
  • Camden: Camden Global Documents > 2WW Suspected Cancer
  • Enfield: ENF Global Documents > 2WW Cancer Referral Forms
  • Haringey: HAR Global Documents > 2WW Cancer Referral Forms
  • Islington: ISL Global Documents > 2WW Cancer Referral Forms

Please check that you are using the correct version of the form on your EMIS system. 

Referrals should be sent via e-RS direct to the hospital.

When referring a patient

Please ensure that the patient is aware of the urgency and reason for the referral, and that they are available and willing to attend an appointment within two weeks.

Patient information leaflets are available for some referral types and in 12 languages from the Transformation Partners in Health and Care website.

See also the Primary care user guide for 2WW suspected cancer referrals.


Locations

Royal Free London

UCLH

Whittington Health

St Mary's

NMUH

Downloads

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NCL FIT<10 secondary care clinical pathway (March 2023)

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How to order/reorder FIT kits (North London Partners in Health and Care)

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NHS Suspected Cancer Referrals SOP using e-RS

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Sarcoma comms (NCL ICB, July 2022)

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National cancer waiting times monitoring dataset guidance (NHS England, 2020)

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Pathway information for patients being investigated for possible gynaecological cancer (North Central and East London Cancer Alliance, January 2020)

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Pathway information for patients being investigated for possible prostate cancer (North Central and East London Cancer Alliance, January 2020)

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Pathway information for patients being investigated for possible colorectal cancer (North Central and East London Cancer Alliance, January 2020)

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Pan London patient information for urgent breast unit referrals (London Cancer Alliance, April 2016)

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Pan London suspected cancer referral changes

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Review date: Wednesday, 24 July 2024