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Cancer Referral Forms

Please find listed below referral forms for all tumour sites.

Wirral University Teaching Hospital NHS Foundation Trust is currently in the process of moving to DBS referral for all suspected cancer referrals and tumour sites (2WW). Please check individual referral forms for the appropriate referral method i.e. via ERS (with proforma attached within 24 hours) or fax to Wirral Choose and Book on 0151 604 7172.

Exceptions to the above include:

  • Brain and CNS referrals which should be directed to The Walton Centre
  • Lung referrals which should have a:

WROCS CXR request (if reported with a “*LUNG TEAM FLAG*” this will be taken as an automatic referral but please note that if reported with an “ALERT: Serious or unexpected finding. *ACTION REQUIRED*” this will NOT be taken as an automatic referral)

OR

WROCS CT scan request (if CXR is normal but there is still clinical suspicion). Please review instructions on the Suspected Lung Cancer Referral Form in line with the new lung cancer optimal pathway for Cheshire & Merseyside

  • Sarcoma referrals which should be directed to the Royal Liverpool University Hospital
  • Upper GI referrals which should be e-mailed to wih-tr.directscope@nhs.net

For any queries please contact Wirral Choose and Book on 0151 604 7720.

 

Suspected Cancer Referral Forms (Referrals to WUTH)

Suspected Breast Cancer Referral Form

Suspected Colorectal Cancer Referral Form

Suspected Gynaecological Cancer Referral Form

Suspected Haematological Cancer Referral Form

Suspected Head & Neck Cancer Referral Form

Suspected Lung Cancer Referral Form

Suspected Skin Cancer Referral Form

Suspected Upper UGI Cancer Referral Form

Suspected Urological Cancer Referral Form

For patients with vague symptoms or those who do not meet the tumour specific 2WW

please refer to Suspected CUP and MUO Cancer Referral Form

 

Cancer Referrals Additional Information (Referrals to WUTH)

Suspected Cancer Referral Patient Letter

Suspected Skin Cancer Referral Information

Suspected Upper GI Cancer Referral Information

 

 

Suspected Cancer Referral Forms (Referrals to WUTH)

Suspected Brain and CNS Referral Form

Suspected Sarcoma Referral Form

 

Suspected Cancer Referrals Additional Information (Referrals to Other Trusts)

Suspected Sarcoma Cancer Referral Information  

 

Family History Referral Forms (WUTH)

Breast Family History Referral Form

Colorectal Family History Referral Form

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