Optimal cancer diagnostic pathways
The formation of Rapid Cancer Diagnostic Services (RCDSs) aims to provide primary care with an alternative, person-centred and fast-tracked pathway to refer patients with non-specific symptoms (such as weight loss, fatigue and nausea) that are suspicious of cancer. Prior to the establishment of the RCDS pathways, patients who do not meet the Scottish Referral Guidelines for Suspected Cancer criteria or who present with non specific but concerning symptoms, could cause their primary care clinician concern, especially if the latter’s ‘gut instinct’ is of a malignancy.
In such cases, primary care would have to coordinate several diagnostic tests, while retaining full clinical responsibility for the patient, or choose to refer to a single cancer specialty that may not be the most appropriate. This process can result in delayed diagnosis, onward referrals to multiple specialties, as well as unnecessary or inconclusive examinations with resulting poorer patient experience and outcomes.
Implementing a faster diagnostic pathway for patients with non-specific symptoms will reduce patient anxiety as they and their families await a diagnosis. A faster diagnosis will also reduce the risk of any cancer growing or spreading, and the risk of overall health status declining, which could mean more patients are unfit for effective treatment by the time their cancer has been diagnosed; even in advanced disease, newer treatments have improved patient outcomes but are highly dependent upon the patient remaining fit enough to receive those treatments. This new referral route also helps ensure patients without cancer are provided with reassurance earlier and, if a non-cancer diagnosis is made, access to any care of treatment they may require.
A Clinical Review of the Scottish Referral Guidelines (SRGs) for Suspected Cancer was undertaken in 2024/25 and published August 2025. This includes a nationally agreed non-specific symptoms pathway for the first time.