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New one-stop clinic for patients with neck lumps

22 October 2020


A new one-stop clinic for patients with neck lumps has been set up at the James Paget to provide a faster route to diagnosis and treatment.

The new clinic started in August and, so far, more than 30 patients have been seen during the Friday morning sessions. Patients are examined and, where an immediate cause can’t be identified, will then be sent for an ultrasound and further tests, usually on the same day, to start the diagnostic process. 

The aim is to get answers for patients as quickly as possible as, in some cases, neck lumps can be an early warning for thyroid, mouth or throat cancer. 

The very first patient through the clinic was referred to the James Paget on July 28 and had an outpatient appointment scheduled for the first clinic on August 7. An ultrasound scan and core biopsy were performed on the same day, and an MRI requested. The MRI went ahead on 12 August and the histology came back on the same day, so the patient attended the next clinic on August 14 for results and also had a chest CT scan. By August 19 a treatment plan involving radiotherapy and concomitant chemotherapy was agreed. 

The total 22 days from referral to treatment plan was six days less than the new 28-day Faster Diagnosis Standard protocol and is an illustration of how quickly things can progress for patients via the clinic. Since then patients have been following a similar path, with those needing treatment going to the Norfolk & Norwich University Hospital for this.

Nikki Szomjas, James Paget Head & Neck Clinical Nurse Specialist - who has been instrumental in establishing the clinic along with Katrina Strak, STP Cancer Transformation Project Manager for the Cancer Services team at the James Paget, and Sheneen Meghji, ENT (Ear, Nose and Throat) Registrar - said; “This has been something we have wanted to do for some time and is key to ensure patients are diagnosed and told what their neck lump is within 28 days. Referrals are triaged to make sure patients can be brought in to the next available clinic. At the moment we can see four new patients and two follow up patients at each clinic and this allows us to fast track those who need further tests.”

The team recognise it can be worrying to find a neck lump and are keen to encourage anyone who may find a lump to contact their GP as soon as they can, as this may put your mind at rest quickly or mean you are diagnosed at an earlier stage.

Nikki says; “One of the first patients to come through the clinic was very reluctant to come into hospital, with work commitments and Covid both considerations. We know it can be difficult to get medical help for fear of what it might be but catching things like this early can give a better prognosis.”

Christopher Speed, from Gorleston, was among the first patients to visit the new clinic. He says; “I found a lump just before I was due to go on holiday but contacted my GP as soon as I returned 10 days later and quickly got an appointment. From there I was referred to the hospital and had the appointment at the neck clinic just a week later. The friendly staff checked my neck and throat and put a camera up my nose and also sent me for an ultrasound scan and biopsies on the same day. I had a CT scan shortly afterwards.

“The whole team made me feel very relaxed and, while I’d felt a little anxious coming into hospital during Covid, you can see all the precautions that have been put in place including the new sinks, hand-sanitisers and separate areas and realise the steps that are being taken.

“I was really surprised – I hadn’t expected everything to be done that quickly, I was just expecting a consultation particularly as with Covid I had expected everything to take longer – I was thinking it might be Christmas before I had an operation.

“Now I’ve already had the operation, and although I will need more treatment, the support I’ve had from the ENT team has been amazing too, with calls every other day checking I’m OK and asking if I have any questions.

“I’m amazed at how quickly everything was done and it’s been a fantastic service from both the James Paget and the Norfolk & Norwich, where I had the operation.

“If you do find a lump I would advise you to get to your doctor as soon as you can. All you hear at the moment is how everything has stopped for Covid-19, but my experience shows treatment is going ahead and can be quick, so please don’t put off going to your GP.”

Lynne Kyle, another of the patients to be referred to the clinic, said she had initially thought her neck lump was a bad insect bite.

“After a few weeks it was still there and I was getting worried so I completed an online form for my doctor and was given an immediate appointment. I was given a referral to the clinic by my GP, attended within 9-10 days and was then sent off for a blood test, an ultrasound and a biopsy. I waited about two minutes for a blood test and then two minutes for an ultrasound - it was all very effective and efficient. I had the tests and a cup of tea and was done within two hours of arriving, it was very quick.

“I’ve since had an MRI scan and a PET scan at the Norfolk & Norwich and it amazed me how quick it was to a treatment plan. At every stage they have been very nice people and, despite the speed that it has all been coming at, I’m glad everything is moving so rapidly. 

“I do worry whether things will be cancelled if Covid gets worse but I would absolutely urge you to go to your GP if you are worried about symptoms and not to waste any time. 

“I’ve met the most amazing, wonderful and kind people and they have been so supportive. The nurses have been brilliant and have said I can phone them at any time. Just knowing they are there is wonderful.” 

Our photo shows Nikki Szomjas, James Paget Head & Neck Clinical Nurse Specialist, and patient Chris Speed being interviewed by Andrew Turner of BBC Radio Norfolk about the clinic.

Head And Neck Clinic Nikki And Chris 1