4. Urgent referral pathways and what to include

Urgent suspected cancer (two-week-wait) pathway

In England and similar UK pathways, patients with suspected oral or oropharyngeal cancer should be referred urgently so they are seen by a specialist promptly (commonly within two weeks). Exact forms and criteria are set by local Integrated Care Boards / cancer networks — always use the current local referral proforma.

When to refer urgently

• Persistent unexplained ulceration
• Unexplained red or mixed red-white patches
• Unexplained oral or neck lumps
• Other red-flag combinations listed in NICE / local guidance (e.g. persistent unexplained lump in neck)

What a good referral includes

• Patient demographics and contact details
• Clear description of the lesion: site, size, colour, duration, symptoms
• Whether the lesion is indurated, ulcerated, bleeding or fixed
• Relevant history: smoking, alcohol, previous cancer, immunosuppression, medications
• Clinical photographs (if your pathway accepts them and consent is recorded)
• Your working concern (e.g. “urgent — suspected oral malignancy”)
• Any interim advice given to the patient

While awaiting the appointment

• Explain why referral is urgent without causing unnecessary alarm — be honest and calm.
• Advise the patient to expect contact from the hospital and to attend.
• Safety-net: if symptoms worsen (e.g. increasing pain, swelling, difficulty swallowing/breathing), seek urgent medical/dental care sooner.
• Do not start empirical treatments that could mask the lesion without a clear benign diagnosis.

Team roles

• Clinician examining: detects, documents, refers.
• Nurse / receptionist: helps complete forms, book follow-up, chase pathway queries.
• Whole team: reinforces tobacco/alcohol advice and supports anxious patients.

Check your practice has an up-to-date oral cancer referral protocol and that all clinicians know where the forms/live links are stored.