Scottish referral guidelines for suspected cancer
Referral guidance:
Referral to secondary care for USC assessment will vary by Health Board – please follow the local pathway.
Referrals will be triaged by secondary care clinicians. It is therefore important that when a person is referred, they are advised they are being referred for assessment, not for a specific investigation (e.g. an endoscopy).
When making a referral for a person with dysphagia it is essential that the correct information is included in the referral form to allow the secondary care team to triage the referral. Please see CfSD’s Dysphagia pathway for guidance.
Overlap with other pathways:
Patients with intra-abdominal cancer can present with symptoms that overlap. Please see Lower GI cancer guideline, Ovarian cancer guideline and Kidney cancer guideline.
A normal Oesophago-Gastro-Duodenoscopy (OGD) or CT alone may be insufficient to exclude an upper GI cancer. Consideration should be given to using both modalities where clinically indicated, depending on symptoms, age, sex and risk factors.
There may also be a role for referral to a local pathway for non-specific symptoms in which cancer is suspected such as GP direct access to CT or to a RCDS. See also the Non-specific symptoms of cancer guideline.
Iron deficiency anaemia (IDA) falls below the 3% threshold for upper GI cancer and is therefore not included in the above USC referral criteria. See Lower gastrointestinal cancer guideline for initial investigation.
Thrombocytosis:
Evidence has identified thrombocytosis as a risk marker for malignancy17. In cases of unexplained thrombocytosis, it is advisable to assess for any signs or symptoms of cancer and if appropriate refer to a tumour specific USC pathway. Please see the section on thrombocytosis in Referral process/Further considerations for assessment and referral.