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[null,"Baseline assessment tool for suspected cancer: recognition and referral (NICE clinical guideline NG12)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Title of guideline.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Suspected cancer: recognition and referral (NICE clinical guideline NG12)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE, 2017. All rights reserved. See Notice of rights.\n"]

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[null,"Baseline assessment tool for suspected cancer: recognition and referral (NICE clinical guideline NG12)"]
[]
[null,null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(E8:E997,\"Yes\")","v":3}]
[null,null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(G8:G997,\"Yes\")","v":0}]
[null,null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(G4/G3),\"\",G4/G3)","v":0}]
[]
[null,"NICE recommendation","Guideline reference","Year of recommendation","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1 Lung and pleural cancers"]
[null,"Lung cancer"]
[null,"Recommendations in this section update recommendations 1.1.2 to 1.1.5 in lung cancer, NICE guideline CG121."]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they:\n•have chest X‑ray findings that suggest lung cancer or\n•are aged 40 and over with unexplained haemoptysis. ","1.1.1","new 2015"]
[null,"Offer an urgent chest X‑ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:\n•cough\n•fatigue\n•shortness of breath\n•chest pain\n•weight loss\n•appetite loss.","1.1.2","new 2015"]
[null,"Consider an urgent chest X‑ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following:\n•persistent or recurrent chest infection \n•finger clubbing \n•supraclavicular lymphadenopathy or persistent cervical lymphadenopathy \n•chest signs consistent with lung cancer \n•thrombocytosis. ","1.1.3","new 2015"]
[null,"Mesothelioma"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for mesothelioma if they have chest X‑ray findings that suggest mesothelioma. ","1.1.4","new 2015"]
[null,"Offer an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if:\n•they have 2 or more of the following unexplained symptoms, or\n•they have 1 or more of the following unexplained symptoms and have ever smoked, or\n•they have 1 or more of the following unexplained symptoms and have been exposed to asbestos:\n◦cough\n◦fatigue\n◦shortness of breath\n◦chest pain\n◦weight loss\n◦appetite loss. ","1.1.5","new 2015"]
[null,"Consider an urgent chest X‑ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over with either:\n•finger clubbing or\n•chest signs compatible with pleural disease.","1.1.6","new 2015"]
[null,"1.2 Upper gastrointestinal tract cancers"]
[null,"Oesophageal cancer"]
[null,"Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people:\n•with dysphagia or\n•aged 55 and over with weight loss and any of the following: \n◦upper abdominal pain \n◦reflux\n◦dyspepsia. ","1.2.1","new 2015"]
[null,"Consider non-urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people with haematemesis. ","1.2.2","new 2015"]
[null,"Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people aged 55 or over with:\n•treatment‑resistant dyspepsia or\n•upper abdominal pain with low haemoglobin levels or\n•raised platelet count with any of the following:\n◦nausea\n◦vomiting\n◦weight loss\n◦reflux\n◦dyspepsia\n◦upper abdominal pain, or\n•nausea or vomiting with any of the following:\n◦weight loss\n◦reflux\n◦dyspepsia\n◦upper abdominal pain.\n","1.2.3","new 2015"]
[null,"Pancreatic cancer"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for pancreatic cancer if they are aged 40 and over and have jaundice. ","1.2.4","new 2015"]
[null,"Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following:\n•diarrhoea\n•back pain\n•abdominal pain\n•nausea\n•vomiting\n•constipation\n•new‑onset diabetes. ","1.2.5","new 2015"]
[null,"Stomach cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer. ","1.2.6","new 2015"]
[null,"Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:\n•with dysphagia or\n•aged 55 and over with weight loss and any of the following:\n◦upper abdominal pain\n◦reflux\n◦dyspepsia. ","1.2.7","new 2015"]
[null,"Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis. ","1.2.8","new 2015"]
[null,"Consider non‑urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with:\n•treatment‑resistant dyspepsia or\n•upper abdominal pain with low haemoglobin levels or\n•raised platelet count with any of the following:\n◦nausea\n◦vomiting \n◦weight loss \n◦reflux\n◦dyspepsia \n◦upper abdominal pain, or\n•nausea or vomiting with any of the following:\n◦weight loss \n◦reflux\n◦dyspepsia \n◦upper abdominal pain. ","1.2.9","new 2015"]
[null,"Gall bladder cancer"]
[null,"Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder.","1.2.10","new 2015"]
[null,"Liver cancer"]
[null,"Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for liver cancer in people with an upper abdominal mass consistent with an enlarged liver. ","1.2.11","new 2015"]
[null,"1.3 Lower gastrointestinal tract cancers"]
[null,"Colorectal cancer"]
[null,"Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:\n•they are aged 40 and over with unexplained weight loss and abdominal pain or\n•they are aged 50 and over with unexplained rectal bleeding or\n•they are aged 60 and over with:\n◦iron‑deficiency anaemia or\n◦changes in their bowel habit, or\n•tests show occult blood in their faeces.","1.3.1","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults with a rectal or abdominal mass.","1.3.2","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:\n•abdominal pain\n•change in bowel habit\n•weight loss\n•iron‑deficiency anaemia. ","1.3.3","new 2015"]
[null,"This recommendation has been replaced by our diagnostics guidance on quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care. The diagnostics guidance recommends tests for occult blood in faeces, for people without rectal bleeding but with unexplained symptoms that do not meet the criteria for a suspected cancer pathway referral in recommendations 1.3.1 to 1.3.3.","1.3.4"]
[null,"Anal cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for anal cancer in people with an unexplained anal mass or unexplained anal ulceration. ","1.3.5","new 2015"]
[null,"1.4 Breast cancer"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:\n•aged 30 and over and have an unexplained breast lump with or without pain or\n•aged 50 and over with any of the following symptoms in one nipple only:\n◦discharge \n◦retraction \n◦other changes of concern. ","1.4.1","new 2015","Yes","Primary care referrals often made on out of date forms or via letter. Internal con to con referrals may be via email, letter or via imaging request forms. Wide variation demonstrated with NICE guideline concordance.","No","Project design and proposal. Secure lead and funding for project. Baseline audit and evidence obtained. Review and update of referral forms (external and internal) with associated stakeholder involvement. Contemporaneous audit to establish benefit post intervention.","Yes","Yes","ASAP","Suzanne Halliday ANP"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:\n•with skin changes that suggest breast cancer or\n•aged 30 and over with an unexplained lump in the axilla.","1.4.2","new 2015","Yes","Primary care referrals often made on out of date forms or via letter. Internal con to con referrals may be via email, letter or via imaging request forms. Wide variation demonstrated with NICE guideline concordance.","No","Referals are often made in this category for individuals with benign dermatological anomalies including sebacious cysts and eczema to the skin which responds effectively to topical hydrocortisone in primary care which has not been considered. Enhanced primary care support to optimise referral type is indicated.","Yes",null,"ASAP","Suzanne Halliday ANP"]
[null,"Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain. See also recommendations 1.16.2 and 1.16.3 for information about seeking specialist advice. ","1.4.3","new 2015","Yes","Primary care referrals often made on out of date forms or via letter. Internal con to con referrals may be via email, letter or via imaging request forms. Wide variation demonstrated with NICE guideline concordance. Very little evidence of robust primary care support for advice and support in primary care relating to low index of suspicion referals prior to referral (eg, breast pain, eczema). Low levels of support requested from primary care (Advice and Guidance Service) in relation to these symptoms.","No","A significant proportion of referrals relate to breast pain with no other symptoms. This is not an NG12 category but is clearly a symptom patients and GPs feel indicates breast specialist input. Further exploration of this issue in relation to enhanced support for patients and referrers utilising the referral process framework may pove beneficial to patients and service outcomes here.","Yes","Yes","ASAP","Suzanne Halliday ANP"]
[null,"1.5 Gynaecological cancers"]
[null,"Ovarian cancer"]
[null,"The recommendations in this section have been incorporated from the NICE guideline on ovarian cancer (NICE guideline CG122, 2011) and have not been updated. The recommendations for ovarian cancer apply to women aged 18 and over."]
[null,"Refer the woman urgently if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).","1.5.1",2011]
[null,"Carry out tests in primary care (see recommendations 1.5.6 to 1.5.9) if a woman (especially if 50 or over) reports having any of the following symptoms on a persistent or frequent basis – particularly more than 12 times per month:\n•persistent abdominal distension (women often refer to this as 'bloating')\n•feeling full (early satiety) and/or loss of appetite\n•pelvic or abdominal pain\n•increased urinary urgency and/or frequency. ","1.5.2",2011]
[null,"Consider carrying out tests in primary care (see recommendations 1.5.6 to 1.5.9) if a woman reports unexplained weight loss, fatigue or changes in bowel habit. ","1.5.3",2011]
[null,"Advise any woman who is not suspected of having ovarian cancer to return to her GP if her symptoms become more frequent and/or persistent. ","1.5.4",2011]
[null,"Carry out appropriate tests for ovarian cancer (see recommendations 1.5.6 to 1.5.9) in any woman of 50 or over who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS), because IBS rarely presents for the first time in women of this age. ","1.5.5",2011]
[null,"Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer (see recommendations 1.5.1 to 1.5.5).","1.5.6",2011]
[null,"If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.","1.5.7",2011]
[null,"If the ultrasound suggests ovarian cancer, refer the woman urgently for further investigation. ","1.5.8",2011]
[null,"For any woman who has normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound:\n•assess her carefully for other clinical causes of her symptoms and investigate if appropriate\n•if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent.","1.5.9",2011]
[null,"Endometrial cancer"]
[null,"Refer women using a suspected cancer pathway referral (for an appointment within 2 weeks) for endometrial cancer if they are aged 55 and over with post‑menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause). ","1.5.10","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for endometrial cancer in women aged under 55 with post‑menopausal bleeding. ","1.5.11","new 2015"]
[null,"Consider a direct access ultrasound scan to assess for endometrial cancer in women aged 55 and over with:\n•unexplained symptoms of vaginal discharge who:\n◦are presenting with these symptoms for the first time or\n◦have thrombocytosis or\n◦report haematuria, or\n•visible haematuria and:\n◦low haemoglobin levels or\n◦thrombocytosis or\n◦high blood glucose levels.","1.5.12","new 2015"]
[null,"Cervical cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for women if, on examination, the appearance of their cervix is consistent with cervical cancer. ","1.5.13","new 2015"]
[null,"Vulval cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vulval cancer in women with an unexplained vulval lump, ulceration or bleeding.  ","1.5.14","new 2015"]
[null,"Vaginal cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina. ","1.5.15","new 2015"]
[null,"1.6 Urological cancers"]
[null,"Prostate cancer"]
[null,"Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination. ","1.6.1","new 2015"]
[null,"Consider a prostate‑specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:\n•any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or\n•erectile dysfunction or\n•visible haematuria. ","1.6.2","new 2015"]
[null,"Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the age‑specific reference range.","1.6.3","new 2015"]
[null,"Bladder cancer"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:\n•aged 45 and over and have:\n◦ unexplained visible haematuria without urinary tract infection or\n◦visible haematuria that persists or recurs after successful treatment of urinary tract infection, or\n•aged 60 and over and have unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test. ","1.6.4","new 2015"]
[null,"Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection. ","1.6.5","new 2015"]
[null,"Renal cancer"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for renal cancer if they are aged 45 and over and have:\n•unexplained visible haematuria without urinary tract infection or\n•visible haematuria that persists or recurs after successful treatment of urinary tract infection. ","1.6.6","new 2015"]
[null,"Testicular cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for testicular cancer in men if they have a non‑painful enlargement or change in shape or texture of the testis. ","1.6.7","new 2015"]
[null,"Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms.","1.6.8","new 2015"]
[null,"Penile cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for penile cancer in men if they have either:\n•a penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause, or\n•a persistent penile lesion after treatment for a sexually transmitted infection has been completed.","1.6.9","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for penile cancer in men with unexplained or persistent symptoms affecting the foreskin or glans. ","1.6.10","new 2015"]
[null,"1.7 Skin cancers"]
[null,"Malignant melanoma of the skin"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma if they have a suspicious pigmented skin lesion with a weighted 7‑point checklist score of 3 or more. ","1.7.1","new 2015"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if dermoscopy suggests melanoma of the skin. ","1.7.2 ","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma in people with a pigmented or non‑pigmented skin lesion that suggests nodular melanoma. ","1.7.3","new 2015"]
[null,"Squamous cell carcinoma"]
[null," Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with a skin lesion that raises the suspicion of squamous cell carcinoma. ","1.7.4","new 2015"]
[null,"Basal cell carcinoma"]
[null,"Consider routine referral for people if they have a skin lesion that raises the suspicion of a basal cell carcinoma. ","1.7.5","new 2015"]
[null,"Only consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with a skin lesion that raises the suspicion of a basal cell carcinoma if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size.","1.7.6","new 2015"]
[null,"Follow the NICE guidance on improving outcomes for people with skin tumours including melanoma: the management of low-risk basal cell carcinomas in the community (2010 update) for advice on who should excise suspected basal cell carcinomas. ","1.7.7","new 2015"]
[null,"1.8 Head and neck cancers"]
[null,"Laryngeal cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:\n•persistent  unexplained hoarseness or \n•an unexplained lump in the neck. ","1.8.1","new 2015"]
[null,"Oral cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:\n•unexplained ulceration in the oral cavity lasting for more than 3 weeks or \n•a persistent and unexplained lump in the neck.  ","1.8.2","new 2015"]
[null,"Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:\n•a lump on the lip or in the oral cavity or\n•a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. ","1.8.3","new 2015"]
[null,"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:\n•a lump on the lip or in the oral cavity consistent with oral cancer or\n•a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.","1.8.4","new 2015"]
[null,"Thyroid cancer"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump. ","1.8.5","new 2015"]
[null,"1.9 Brain and central nervous system cancers"]
[null,"Adults"]
[null,"Consider an urgent direct access MRI scan of the brain (or CT scan if MRI is contraindicated) (to be performed within 2 weeks) to assess for brain or central nervous system cancer in adults with progressive, sub‑acute loss of central neurological function.","1.9.1","new 2015"]
[null,"Children and young people"]
[null,"Consider a very urgent referral (for an appointment within 48 hours) for suspected brain or central nervous system cancer in children and young people with newly abnormal cerebellar or other central neurological function.","1.9.2","new 2015"]
[null,"1.10 Haematological cancers"]
[null,"Leukaemia in adults"]
[null,"Consider a very urgent full blood count (within 48 hours) to assess for leukaemia in adults with any of the following:\n•pallor\n• persistent fatigue\n• unexplained fever\n•unexplained persistent or recurrent infection\n•generalised lymphadenopathy\n•unexplained bruising\n•unexplained bleeding\n•unexplained petechiae\n•hepatosplenomegaly.","1.10.1","new 2015"]
[null,"Leukaemia in children and young people"]
[null,"Refer children and young people for immediate specialist assessment for leukaemia if they have unexplained petechiae or hepatosplenomegaly.","1.10.2","new 2015"]
[null,"Offer a very urgent full blood count (within 48 hours) to assess for leukaemia in children and young people with any of the following:\n•pallor\n•persistent fatigue\n•unexplained fever\n•unexplained persistent infection\n•generalised lymphadenopathy\n•persistent or unexplained bone pain\n•unexplained bruising\n•unexplained bleeding.","1.10.3","new 2015"]
[null,"Myeloma"]
[null,"Offer a full blood count, blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate to assess for myeloma in people aged 60 and over with persistent bone pain, particularly back pain, or unexplained fracture.","1.10.4","new 2015"]
[null,"Offer very urgent protein electrophoresis and a Bence‑Jones protein urine test (within 48 hours) to assess for myeloma in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma. ","1.10.5","new 2015"]
[null,"Consider very urgent protein electrophoresis and a Bence‑Jones protein urine test (within 48 hours) to assess for myeloma if the plasma viscosity or erythrocyte sedimentation rate and presentation are consistent with possible myeloma. ","1.10.6","new 2015"]
[null,"Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if the results of protein electrophoresis or a Bence‑Jones protein urine test suggest myeloma. ","1.10.7","new 2015"]
[null,"Non‑Hodgkin's lymphoma in adults"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for non‑Hodgkin's lymphoma in adults presenting with unexplained lymphadenopathy or splenomegaly. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss.","1.10.8","new 2015"]
[null,"Non‑Hodgkin's lymphoma in children and young people"]
[null,"Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for non‑Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy or splenomegaly. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss. ","1.10.9","new 2015"]
[null,"Hodgkin's lymphoma in adults"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for Hodgkin's lymphoma in adults presenting with unexplained lymphadenopathy. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus, weight loss or alcohol‑induced lymph node pain.","1.10.10","new 2015"]
[null,"Hodgkin's lymphoma in children and young people"]
[null,"Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss.","1.10.11","new 2015"]
[null,"1.11 Sarcomas"]
[null,"Bone sarcoma in adults"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if an X‑ray suggests the possibility of bone sarcoma. ","1.11.1","new 2015"]
[null,"Bone sarcoma in children and young people"]
[null,"Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for children and young people if an X‑ray suggests the possibility of bone sarcoma. ","1.11.2","new 2015"]
[null,"Consider a very urgent direct access X‑ray (to be performed within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.","1.11.3","new 2015"]
[null,"Soft tissue sarcoma in adults"]
[null,"Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size.","1.11.4","new 2015"]
[null,"Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists. ","1.11.5","new 2016"]
[null,"Soft tissue sarcoma in children and young people"]
[null,"Consider a very urgent direct access ultrasound scan (to be performed within 48 hours) to assess for soft tissue sarcoma in children and young people with an unexplained lump that is increasing in size. ","1.11.6","new 2015"]
[null,"Consider a very urgent referral (for an appointment within 48 hours) for children and young people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists.","1.11.7","new 2015"]
[null,"1.12 Childhood cancers"]
[null,"Neuroblastoma"]
[null,"Consider very urgent referral (for an appointment within 48 hours) for specialist assessment for neuroblastoma in children with a palpable abdominal mass or unexplained enlarged abdominal organ. ","1.12.1","new 2015"]
[null,"Retinoblastoma"]
[null,"Consider urgent referral (for an appointment within 2 weeks) for ophthalmological assessment for retinoblastoma in children with an absent red reflex. ","1.12.2","new 2015"]
[null,"Wilms' tumour"]
[null,"Consider very urgent referral (for an appointment within 48 hours) for specialist assessment for Wilms' tumour in children with any of the following:\n•a palpable abdominal mass\n•an unexplained enlarged abdominal organ\n•unexplained visible haematuria. ","1.12.3","new 2015"]
[null,"1.13 Non‑site‑specific symptoms"]
[null,"Symptoms of concern in children and young people"]
[null,"Take into account the insight and knowledge of parents and carers when considering making a referral for suspected cancer in a child or young person. Consider referral for children if their parent or carer has persistent concern or anxiety about the child's symptoms, even if the symptoms are most likely to have a benign cause.","1.13.1",2015]
[null,"Symptoms of concern in adults"]
[null,"For people with unexplained weight loss, which is a symptom of several cancers including colorectal, gastro‑oesophageal, lung, prostate, pancreatic and urological cancer:\n•carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely and\n•offer urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks). ","1.13.2","new 2015"]
[null,"For people with unexplained appetite loss, which is a symptom of several cancers including lung, oesophageal, stomach, colorectal, pancreatic, bladder and renal cancer:\n•carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely and\n•offer urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks).","1.13.3","new 2015"]
[null,"For people with deep vein thrombosis, which is associated with several cancers including urogenital, breast, colorectal and lung cancer:\n•carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely and\n•consider urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks).","1.13.4","new 2015"]
[null,"1.14 Patient information and support"]
[null,"Discuss with people with suspected cancer (and their carers as appropriate, taking account of the need for confidentiality) their preferences for being involved in decision‑making about referral options and further investigations including their potential risks and benefits. ","1.14.1",2015]
[null,"When cancer is suspected in a child, discuss the referral decision and information to be given to the child with the parents or carers (and the child if appropriate). ","1.14.2",2015]
[null,"Explain to people who are being referred with suspected cancer that they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss alternative diagnoses with them. ","1.14.3",2015]
[null,"Give the person information on the possible diagnosis (both benign and malignant) in accordance with their wishes for information (see also the NICE guideline on patient experience in adult NHS services). ","1.14.4",2015]
[null,"The information given to people with suspected cancer and their families and/or carers should cover, among other issues:\n•where the person is being referred to\n•how long they will have to wait for the appointment\n•how to obtain further information about the type of cancer suspected or help before the specialist appointment\n•what to expect from the service the person will be attending\n•what type of tests may be carried out, and what will happen during diagnostic procedures\n•how long it will take to get a diagnosis or test results\n•whether they can take someone with them to the appointment \n•who to contact if they do not receive confirmation of an appointment\n•other sources of support. ","1.14.5","new 2015"]
[null,"Provide information that is appropriate for the person in terms of language, ability and culture, recognising the potential for different cultural meanings associated with the possibility of cancer. ","1.14.6",2015]
[null,"Have information available in a variety of formats on both local and national sources of information and support for people who are being referred with suspected cancer. For more information on information sharing, see section 1.5 in the NICE guideline on patient experience in adult NHS services. ","1.14.7","new 2015"]
[null,"Reassure people in the safety netting group (see recommendation 1.15.2) who are concerned that they may have cancer that with their current symptoms their risk of having cancer is low. ","1.14.8","new 2015"]
[null,"Explain to people who are being offered safety netting (see recommendation 1.15.2) which symptoms to look out for and when they should return for re‑evaluation. It may be appropriate to provide written information. ","1.14.9","new 2015"]
[null,"When referring a person with suspected cancer to a specialist service, assess their need for continuing support while waiting for their referral appointment. This should include inviting the person to contact their healthcare professional again if they have more concerns or questions before they see a specialist. ","1.14.10",2005]
[null,"If the person has additional support needs because of their personal circumstances, inform the specialist (with the person's agreement). ","1.14.11",2005]
[null,"1.15 Safety netting"]
[null,"Ensure that the results of investigations are reviewed and acted upon appropriately, with the healthcare professional who ordered the investigation taking or explicitly passing on responsibility for this. Be aware of the possibility of false‑negative results for chest X‑rays and tests for occult blood in faeces","1.15.1","new 2015"]
[null,"Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action. The review may be:\n•planned within a time frame agreed with the person or\n•patient‑initiated if new symptoms develop, the person continues to be concerned, or their symptoms recur, persist or worsen. ","1.15.2","new 2015"]
[null,"1.16 The diagnostic process"]
[null,"Take part in continuing education, peer review and other activities to improve and maintain clinical consulting, reasoning and diagnostic skills, in order to identify at an early stage people who may have cancer, and to communicate the possibility of cancer to the person. ","1.16.1",2005]
[null,"Discussion with a specialist (for example, by telephone or email) should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical.","1.16.2",2005]
[null,"Put in place local arrangements to ensure that letters about non-urgent referrals are assessed by the specialist, so that the person can be seen more urgently if necessary. ","1.16.3",2005]
[null,"Put in place local arrangements to ensure that there is a maximum waiting period for non‑urgent referrals, in accordance with national targets and local arrangements.","1.16.4",2005]
[null,"Ensure local arrangements are in place to identify people who miss their appointments so that they can be followed up. ","1.16.5",2005]
[null,"Include all appropriate information in referral correspondence, including whether the referral is urgent or non‑urgent. ","1.16.6",2005]
[null,"Use local referral proformas if these are in use. ","1.16.7",2005]
[null,"Once the decision to refer has been made, make sure that the referral is made within 1 working day. ","1.16.8",2005]

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