Evaluating the Clinical Utility of Routine Blood Tests in the Urgent Suspected Cancer Neck Lump Pathway: A Retrospective 6-Month Analysis

Problem: Routine blood tests are commonly used as part of clinical investigations for assessing neck lumps. The diagnostic value of their use within the Head and Neck (H&N) two-week-wait (2WW) suspected cancer referral pathway is currently unclear. Methods: A retrospective review of 138 patients referred via the H&N 2WW Telephone Assessment Clinics (TAC, n=82) and neck lump Straight-to-Test pathway (STT, n=56) from September 2024 to March 2025 was conducted. Patients were grouped by blood test status (normal, abnormal, or not done), and outcomes were compared against confirmed cancer diagnoses. Results: Twelve patients were diagnosed with malignancy. There was no significant association between blood test results and cancer diagnosis (p=0.529). Abnormal bloods were common but rarely influenced management. Non-attendance rates were high, with 27.5% of patients overall and 33% of those in the thyroid lump subgroup not completing requested blood tests, reflecting inefficiencies in clinical resource use. Thyroid function tests (TFTs) were not diagnostic for cancer, but they helped guide the management of benign thyroid conditions. Conclusions: Routine blood tests showed limited value in cancer detection and were associated with low attendance and added clinical burden. A more selective, indication-based approach to testing is recommended in the H&N 2WW pathway.