Brain and Central Nervous System Cancer
NHS Tayside RefGuide
Full guideline available here:
Scottish Referral Guidelines for Suspected Cancer – Brain and Central Nervous System (CNS) Cancers
Who to refer
Urgent Suspicion of Cancer Referral
Refer a person with a headache where there is concern about a brain/CNS cancer plus 1 or more of the following features as an Urgent Suspicion of Cancer (USC):
- Cognitive change – symptomatic or noted by others
- Personality change
- History of cancer (especially lung, breast, melanoma, or renal)
- History of HIV
Emergency (same day) referral
Refer a person with 2 or more of the following as an Emergency (same day) via switchboard to the on-call medic:
- New headache
- New seizure
- Papilloedema
- New focal neurological deficit
Primary Care Investigation
Request GP Direct Access CT Head as a USC priority
Who not to refer
Headache management:
Many people presenting with headache will not fit into the referral guidelines above. The Centre for Sustainable Delivery (CfSD) has published the National Headache Pathway to guide referral in other scenarios.
Papilloedema or Visual Field loss:
Refer a person urgently to an optometrist for assessment if there is uncertainty about the presence of papilloedema or visual field loss.
How to refer
Patients should be referred via SCI Gateway as a USC, and in accordance with the Scottish Referral Guidelines for Suspected Cancer.
If you are unsure about whether this is the correct referral route, please consider using the SCI Advice Option for further information.
Good practice points:
- It is good practice to explain to patients that they’re being referred on a USC pathway and using the word “cancer” as a reason for investigation or referral unless there is serious concern about causing unwarranted distress. Use the Cancer Research UK resource ‘Your Suspected Cancer Referral Explained’ to support your conversations.
- Further good practice is to assess general fitness, frailty, and/or performance status recording this in the referral (e.g. ECOG/WHO performance status and Clinical Frailty Scale) to facilitate discussion about the most appropriate investigations. Early optimisation or prehabilitation can enable treatment and improve outcomes. Further information and resources for patients and health care professionals is available at Prehabilitation for Scotland.
- It should also be recognised that there are occasions when intrusive intervention is not in a person’s best interests. Please identify if they have dementia, if they have a POA, Guardianship, or AWI. There should be full discussion about alternative approaches, including with relevant others if a person lacks capacity, complying with the Adults with Incapacity (Scotland) Act 2000.
Patient Leaflets (Links to any NHS Tayside, National or Online resources)
Adult Brain Cancer – Cancer Patient Information
Useful resources and information
Better safe than tumour - Signs and Symptoms
Scottish Cancer Network Neuro-Oncology Clinical Management Pathway