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Lymphadenopathy for investigation

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Emergency treatment required - needs discussion with on call specialist and/or emergency department.

 

  • Symptoms of airway obstruction, SVC obstruction
  • Severe gastrointestinal (GI) bleeding
  • Bowel obstruction
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure/dysfunction
  • Uncontrolled and disabling pain
  • Massive haemoptysis and/or stridor
  • Neurological signs suggestive of brain metastases or cord compression
  • Very high calcium (3.0mmol/L)
  • Severe dysphagia with dehydration
  • Biopsy proven small cell lung cancer
    • patients with symptoms of shortness of breath, deteriorating organ function
  • Metastatic germ cell tumour (GCT) confirmed (biopsy) or suspected (tumour markers)
  • Patients with severe symptoms, organ failure or life threatening complications
  • Highly aggressive lymphoma
    • Burkitt’s lymphoma
    • lymphoblastic lymphoma
  • Acute leukaemia
  • Suspected spinal cord compression, superior vena cava syndrome (SVC), high calcium (>3.0mmol/L), febrile neutropenia need to be referred to the emergency department urgently.
  • Haematology department accepts referrals of patients with clinically abnormal lymph nodes without a biopsy
  • For clinically stable small - volume lymph nodes and in a well patient with normal blood work suggest:
    • clinical monitoring recommended
    • consider biopsy
    • for isolated neck lymphadenopathy, fine needle aspiration is usually the first investigation to exclude head and neck squamous cell cancer. Excisional biopsy of isolated neck lymph nodes should only be undertaken once squamous cell cancer has been excluded
  • Optimal cancer care pathway for people with Hodgkin and diffuse B-cell lymphomas
  • Quick reference guide

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Abnormal lymph node (LN) detected clinically or via imaging – and not biopsied (or inconclusive biopsy). For optimum care, patient should be seen within 2 weeks.
    • AND if ANY of the following are present (For optimum care, patient should be seen within 2 weeks):
      • symptomatic lymphadenopathy
      • raised LDH
      • bulky disease (>3cm diameter of LN mass)
      • presence of fever, night sweats, weight loss or new onset pruritus
      • concurrent recent onset cytopenias (e.g. anaemia, thrombocytopenia)
      • extranodal masses
      • clinical history of rapid growth
    • AND if ALL the following are present:
      • Asymptomatic or minimally symptomatic lymphadenopathy
      • Normal FBC and stable creatinine and liver function
      • Clinical history of slow growth
      • Non bulky disease
      • Clinically well (absence of the following - fever, night sweats, weight loss or pruritus)
  • Category 2
    (appointment within 90 calendar days)
    • No category 2 criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • General referral information
  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • FBC ELFTs LDH CMP results

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.