Should I see a nasopharyngeal cancer specialist?

It can be very difficult for GPs to decide who to refer to a specialist. With many symptoms, it is perfectly right that your GP should ask you to wait to see if your symptoms go away on their own, or respond to treatment such as antibiotics. If GPs referred everyone with any symptom to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn't be able to get them.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs to help them decide which patients need to see a specialist urgently. These guidelines about referrals for head and neck cancers were revised in June 2005.

While reading these guidelines, it is important to remember that

• Nasopharyngeal cancers are rare
• A number of risk factors affect your chances of developing a nasopharyngeal cancer

The NICE guidelines say you should get an appointment within 2 weeks for an urgent referral.

The symptoms that need urgent referral for possible nasopharyngeal cancer are

• Unexplained red and white patches in your mouth that are painful, swollen or bleeding
• Unexplained ulceration (an area that is red and sore) or a lump in your mouth for more than 3 weeks
• An unexplained lump in your neck that is new or has changed in the previous 3 to 6 weeks
• Unexplained swelling in the glands under your ear, or around your lower jaw, that does not go away
• Unexplained pain on one side of your head and neck for more than 4 weeks, with earache
• An unexplained sore or painful throat that has lasted longer than it should

If you have a loose tooth for more than 3 weeks for no apparent reason, your doctor may refer you to a dentist urgently.

The guidelines also say the GP should send you for an urgent chest X-ray if you have had a hoarse, husky or quieter than normal voice for more than 3 weeks, particularly if you are a smoker over the age of 50 or a heavy drinker. The reason for the X-ray is to try to be clear whether you have a suspected lung cancer or head and neck cancer.

It is important to remember that some of these symptoms can be caused by other less serious medical conditions. These symptoms do not always mean that you have cancer of the nasopharynx.

If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, you could print this page, and the symptoms page, and take them along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist, and if so, how soon.