Guidance
Recommendations organised by symptom and findings of primary care investigations
Recommendations organised by symptom and findings of primary care investigations
The recommendations in this section are displayed alphabetically by symptom then in order of urgency of the action needed, to make sure that the most urgent actions are not missed. Where there are several recommendations relating to the same cancer these have been grouped for ease of reference. Occasionally the same symptom may suggest more than one cancer site. In such instances the recommendations are displayed together and the GP should use their clinical judgement to decide on the most appropriate action.
Use this guideline to guide referrals. If still uncertain about whether a referral is needed, consider contacting a specialist (see the recommendations on the diagnostic process). Consider a review for people with any symptom associated with increased cancer risk who do not meet the criteria for referral or investigative action (see the recommendations on safety netting).
Abdominal symptoms
See also the section on bleeding for recommendations on rectal bleeding.
Possible cancer |
Recommendation |
|
---|---|---|
Abdominal distension (persistent or frequent – particularly more than 12 times per month) in women, especially if 50 and over |
Ovarian |
Carry out tests in primary care [1.5.2] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for more information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Symptoms and signs |
Possible cancer |
Recommendation |
---|---|---|
Ascites and/or a pelvic or abdominal mass identified by physical examination (which is not obviously uterine fibroids) in women |
Ovarian |
Urgent referral [1.5.1] These recommendations apply to women aged 18 and over |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Abdominal or pelvic mass identified by physical examination (which is not obviously uterine fibroids) in women |
Ovarian |
Urgent referral [1.5.1] These recommendations apply to women aged 18 and over |
Abdominal mass |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Rectal mass |
Colorectal |
Consider a suspected cancer pathway referral for an appointment within 2 weeks [1.3.5] |
Splenomegaly (unexplained) in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Upper abdominal mass consistent with stomach cancer |
Stomach |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.2.6] |
Upper abdominal mass consistent with an enlarged gall bladder |
Gall bladder |
Consider an urgent direct access ultrasound scan (to be done within 2 weeks) [1.2.10] |
Upper abdominal mass consistent with an enlarged liver |
Liver |
Consider an urgent direct access ultrasound scan (to be done within 2 weeks) [1.2.11] |
Hepatosplenomegaly |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Abdominal pain with weight loss (unexplained), 40 and over |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Abdominal pain (unexplained) with rectal bleeding in adults under 50 |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
|
Upper abdominal pain with weight loss, 55 and over |
Oesophageal or stomach |
Offer urgent direct access upper gastrointestinal endoscopy (to be done within 2 weeks) [1.2.1] [1.2.7] |
Upper abdominal pain with low haemoglobin levels or raised platelet count or nausea or vomiting, 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Abdominal or pelvic pain (persistent or frequent – particularly more than 12 times per month) in women, especially if 50 and over |
Ovarian |
Carry out tests in primary care [1.5.2] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for more information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Abdominal pain with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Irritable bowel syndrome symptoms within the last 12 months in women 50 and over |
Ovarian |
Carry out appropriate tests for ovarian cancer, because irritable bowel syndrome rarely presents for the first time in women of this age [1.5.5] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for more information on tests for ovarian cancer These recommendations apply to women aged 18 and over Also see the NICE guideline on irritable bowel syndrome in adults. |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Change in bowel habit |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Change in bowel habit (unexplained) in women |
Ovarian |
Consider carrying out tests in primary care [1.5.3] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Diarrhoea or constipation with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Irritable bowel syndrome symptoms within the last 12 months, in women 50 and over |
Ovarian |
Carry out appropriate tests for ovarian cancer, because irritable bowel syndrome rarely presents for the first time in women of this age [1.5.5] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for more information about tests for ovarian cancer These recommendations apply to women aged 18 and over Also see the NICE guideline on irritable bowel syndrome in adults |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Dyspepsia (treatment‑resistant), 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Dyspepsia Dyspepsia with weight loss, 55 and over |
Oesophageal or stomach |
Offer urgent direct access upper gastrointestinal endoscopy (to be done within 2 weeks) [1.2.1] [1.2.7] |
Dyspepsia with raised platelet count or nausea or vomiting, 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Dysphagia |
Oesophageal or stomach |
Offer urgent direct access upper gastrointestinal endoscopy (to be done within 2 weeks) [1.2.1, 1.2.7] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Nausea or vomiting with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Nausea or vomiting with raised platelet count or weight loss or reflux or dyspepsia or upper abdominal pain, 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Symptom and signs |
Possible cancer |
Recommendation |
---|---|---|
Prostate feels malignant on digital rectal examination, in men |
Prostate |
Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.1] |
Anal mass or anal ulceration (unexplained) |
Anal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.3.6] |
Rectal mass |
Colorectal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.3.5] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Reflux with weight loss, 55 and over |
Oesophageal or stomach |
Offer urgent direct access upper gastrointestinal endoscopy (to be done within 2 weeks) [1.2.1] [1.2.7] |
Reflux with raised platelet count or nausea or vomiting, 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Bleeding
See also:
-
the section on urological symptoms for haematuria
-
the section on primary care investigations for faecal occult blood.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Bleeding, bruising or petechiae (unexplained) |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Haematemesis |
Oesophageal or stomach |
Consider non-urgent, direct access upper gastrointestinal endoscopy [1.2.2] [1.2.8] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Haemoptysis (unexplained), 40 and over |
Lung |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.1.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Post‑menopausal bleeding in women 55 and over |
Endometrial |
Refer women using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.10] |
Post‑menopausal bleeding in women under 55 |
Endometrial |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.11] |
Post‑menopausal bleeding is unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Rectal bleeding (unexplained), 50 and over |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Rectal bleeding with unexplained abdominal pain or weight loss in adults under 50 |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Vulval bleeding (unexplained) in women |
Vulval |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.14] |
Gynaecological symptoms
See also the section on bleeding for post‑menopausal (vaginal) bleeding
Symptom and signs |
Possible cancer |
Recommendation |
---|---|---|
Appearance of cervix consistent with cervical cancer |
Cervical |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.13] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Vaginal discharge (unexplained) either at first presentation or with thrombocytosis or with haematuria, in women 55 and over |
Endometrial |
Consider a direct access ultrasound scan [1.5.12] |
Vaginal mass (unexplained and palpable) in or at the entrance to the vagina |
Vaginal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.15] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Vulval bleeding (unexplained) |
Vulval |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.14] |
Vulval lump or ulceration (unexplained) |
Vulval |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.14] |
Lumps or masses
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Anal mass (unexplained) |
Anal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.3.6] |
Axillary lump (unexplained), 30 and over |
Breast |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.4.2] |
Breast lump (unexplained) with or without pain, 30 and over |
Breast |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.4.1] |
Breast lump (unexplained) with or without pain, under 30 |
Breast |
Consider non-urgent referral See also recommendations 1.16.2 and 1.16.3 for information about seeking specialist advice [1.4.3] |
Lip or oral cavity lump |
Oral |
Consider an urgent referral (for an appointment within 2 weeks) for assessment by a dentist [1.8.3] Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) in people when assessed by a dentist as having a lump on the lip or in the oral cavity consistent with oral cancer [1.8.4] |
Lump (unexplained) that is increasing in size in adults |
Soft tissue sarcoma |
Consider an urgent direct access ultrasound scan (to be done within 2 weeks) [1.11.4] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Neck lump (unexplained), 45 and over |
Laryngeal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.8.1] |
Neck lump (persistent and unexplained) |
Oral |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.8.2] |
Penile mass (and sexually transmitted infection has been excluded as a cause) in men |
Penile |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.9] |
Thyroid lump (unexplained) |
Thyroid |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.8.5] |
Vaginal mass (unexplained and palpable) in or at the entrance to the vagina in women |
Vaginal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.15] |
Vulval lump (unexplained) in women |
Vulval |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.14] |
See also the section on abdominal symptoms for abdominal, anal, pelvic and rectal lumps or masses.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Lymphadenopathy (unexplained) in adults |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) When considering referral for Hodgkin's lymphoma, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus, weight loss or alcohol‑induced lymph node pain [1.10.10] When considering referral for non‑Hodgkin's lymphoma, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Lymphadenopathy (supraclavicular or persistent cervical), 40 and over |
Lung |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.3] |
Lymphadenopathy (generalised) in adults |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Ulceration in the oral cavity (unexplained and lasting for more than 3 weeks) |
Oral |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.8.2] |
Lip or oral cavity lump |
Oral |
Consider an urgent referral (for an appointment within 2 weeks) for assessment by a dentist [1.8.3] Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) in people when assessed by a dentist as having a lump on the lip or in the oral cavity consistent with oral cancer [1.8.4] |
Neurological symptoms in adults
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Loss of central neurological function (progressive, sub‑acute) in adults |
Brain or central nervous system |
Consider an urgent direct access MRI scan of the brain (or CT scan if MRI is contraindicated; to be done within 2 weeks) [1.9.1] |
Pain
See also the section on abdominal symptoms for abdominal or pelvic pain.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Alcohol‑induced lymph node pain with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Back pain with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Back pain (persistent), 60 and over |
Myeloma |
Offer a full blood count and blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate [1.10.4] See the section on primary care investigations for more information on tests for myeloma |
Bone pain (persistent), 60 and over |
Myeloma |
Offer a full blood count and blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate to assess for myeloma [1.10.4] See the section on primary care investigations for more information on tests for myeloma |
Chest pain (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Chest pain (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Chest pain (unexplained) with cough or fatigue or shortness of breath or weight loss or appetite loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Respiratory symptoms
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Chest infection (persistent or recurrent), 40 and over |
Lung |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.3] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Chest pain (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Chest pain (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Chest pain (unexplained) with cough or fatigue or shortness of breath or weight loss or appetite loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Cough (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Cough (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Cough (unexplained) with fatigue or shortness of breath or chest pain or weight loss or appetite loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Hoarseness (persistent and unexplained), 45 and over |
Laryngeal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.8.1] |
Symptom and signs |
Possible cancer |
Recommendation |
---|---|---|
Chest signs consistent with lung cancer, 40 and over |
Lung |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.3] |
Chest signs compatible with pleural disease, 40 and over |
Mesothelioma |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.6] |
Finger clubbing, 40 and over |
Lung or mesothelioma |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.3] [1.1.6] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Shortness of breath (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Shortness of breath (unexplained), 40 and over, and exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Shortness of breath with cough or fatigue or chest pain or weight loss or appetite loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Shortness of breath with unexplained lymphadenopathy in adults |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Shortness of breath with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Skeletal symptoms
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Back pain with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Back pain (persistent), 60 and over |
Myeloma |
Offer a full blood count and blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate [1.10.4] See the section on primary care investigations for more information on tests for myeloma |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Bone pain (persistent), 60 and over |
Myeloma |
Offer a full blood count and blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate to assess for myeloma [1.10.4] See the section on primary care investigations for more information on tests for myeloma |
Possible cancer |
Recommendation |
|
---|---|---|
Fracture (unexplained), 60 and over |
Myeloma |
Offer a full blood count and blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate [1.10.4] See the section on primary care investigations for more information on tests for myeloma |
Skin or surface symptoms
See also the section on lumps or masses for oral lesions.
Symptoms and signs |
Possible cancer |
Recommendation |
---|---|---|
Anal ulceration (unexplained) |
Anal |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.3.6] |
Bruising (unexplained) in adults |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Nipple changes of concern (in one nipple only) including discharge and retraction, 50 and over |
Breast |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.4.1] |
Oral cavity red or red and white patch consistent with erythroplakia or erythroleukoplakia |
Oral |
Consider urgent referral (for an appointment within 2 weeks) for assessment by a dentist [1.8.3] Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for people when assessed by a dentist as having a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia [1.8.4] |
Pallor |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Penile lesion (ulcerated and sexually transmitted infection has been excluded, or persistent after treatment for a sexually transmitted infection has been completed) in men |
Penile |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.9] |
Penile mass (and sexually transmitted infection has been excluded as a cause) in men |
Penile |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.9] |
Penile symptoms affecting the foreskin or glans (unexplained or persistent) in men |
Penile |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.10] |
Petechiae (unexplained) in adults |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Pruritus with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Pruritus with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma or non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Skin changes that suggest breast cancer |
Breast |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.4.2] |
Skin lesion (pigmented and suspicious) with a weighted 7‑point checklist score of 3 or more |
Melanoma |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.7.1] |
Skin lesion (pigmented or non‑pigmented) that suggests nodular melanoma |
Melanoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.7.3] |
Skin lesion that raises the suspicion of a squamous cell carcinoma |
Squamous cell carcinoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.7.4] |
Skin lesion that raises the suspicion of a basal cell carcinoma |
Basal cell carcinoma |
Consider routine referral [1.7.5] Only consider a suspected cancer pathway referral (for an appointment within 2 weeks) if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size [1.7.6] Typical features of basal cell carcinoma include: an ulcer with a raised rolled edge; prominent fine blood vessels around a lesion; or a nodule on the skin (particularly pearly or waxy nodules) |
Vulval lump or ulceration (unexplained) in women |
Vulval |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.5.14] |
Urological symptoms
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Dysuria with unexplained non‑visible haematuria, 60 and over |
Bladder |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.4] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Erectile dysfunction in men |
Prostate |
Consider a prostate‑specific antigen (PSA) test and digital rectal examination [1.6.2] See the section on primary care investigations for more information on PSA tests and digital rectal examination |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Haematuria (visible and unexplained) either without urinary tract infection or that persists or recurs after successful treatment of urinary tract infection, 45 and over |
Bladder or renal |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.4] [1.6.6] |
Haematuria (non‑visible and unexplained) with dysuria or raised white cell count on a blood test, 60 and over |
Bladder |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.4] |
Haematuria (visible) with low haemoglobin levels or thrombocytosis or high blood glucose levels or unexplained vaginal discharge in women 55 and over |
Endometrial |
Consider a direct access ultrasound scan [1.5.12] |
Haematuria (visible) in men |
Prostate |
Consider a prostate‑specific antigen (PSA) test and digital rectal examination [1.6.2] See the section on primary care investigations for more information on PSA tests and digital rectal examination |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Testis enlargement or change in shape or texture (non‑painful) in men |
Testicular |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.7] |
Testicular symptoms (unexplained or persistent) in men |
Testicular |
Consider a direct access ultrasound scan [1.6.8] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Urinary tract infection (unexplained and recurrent or persistent), 60 and over |
Bladder |
Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection [1.6.5] |
Lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention in men |
Prostate |
Consider a prostate‑specific antigen (PSA) test and digital rectal examination [1.6.2] See the section on primary care investigations for more information on PSA tests and digital rectal examination |
Urinary urgency or frequency (increased and persistent or frequent – particularly more than 12 times per month) in women, especially if 50 and over |
Ovarian |
Carry out tests in primary care [1.5.2] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Non‑specific features of cancer
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Appetite loss (unexplained) |
Several, including lung, oesophageal, stomach, colorectal, pancreatic, bladder or renal |
Carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely Offer urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks) [1.13.3] |
Appetite loss (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Appetite loss (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Appetite loss (unexplained) with cough or fatigue or shortness of breath or chest pain or weight loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Appetite loss or early satiety (persistent or frequent – particularly more than 12 times per month) in women, especially if 50 and over |
Ovarian |
Carry out tests in primary care [1.5.2] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Deep vein thrombosis |
Several, including urogenital, breast, colorectal and lung |
Carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely Consider urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks) [1.13.4] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Diabetes (new onset) with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or urgent ultrasound scan if CT is not available [1.2.5] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Fatigue (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Fatigue (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Fatigue with cough or shortness of breath or chest pain or weight loss or appetite loss (unexplained), 40 and over |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Fatigue (persistent) in adults |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Fatigue (unexplained) in women |
Ovarian |
Carry out tests in primary care [1.5.2] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Fever (unexplained) |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Fever with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Fever with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma or non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
See also the section on respiratory symptoms for chest infection.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Infection (unexplained and persistent or recurrent) in adults |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Night sweats with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Night sweats with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma or Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Pallor |
Leukaemia |
Consider a very urgent full blood count (within 48 hours) [1.10.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Pruritus with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Pruritus with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma or non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Weight loss (unexplained) |
Several, including colorectal, gastro‑oesophageal, lung, prostate, pancreatic or urological cancer |
Carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely Offer urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks) [1.13.2] |
Weight loss (unexplained) with abdominal pain, 40 and over |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Weight loss (unexplained) with rectal bleeding in adults under 50 |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Weight loss (unexplained), 50 and over |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Weight loss (unexplained), 40 and over, ever smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Weight loss (unexplained), 40 and over, exposed to asbestos |
Mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.5] |
Weight loss with cough or fatigue or shortness of breath or chest pain or appetite loss (unexplained), 40 and over, never smoked |
Lung or mesothelioma |
Offer an urgent chest X‑ray (to be done within 2 weeks) [1.1.2] [1.1.5] |
Weight loss with unexplained splenomegaly in adults |
Non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Weight loss with unexplained lymphadenopathy in adults |
Hodgkin's lymphoma or non‑Hodgkin's lymphoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms [1.10.8] [1.10.10] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Weight loss with upper abdominal pain or reflux or dyspepsia, 55 and over |
Oesophageal or stomach |
Offer urgent direct access upper gastrointestinal endoscopy (to be done within 2 weeks) [1.2.1] [1.2.7] |
Weight loss (unexplained) in women |
Ovarian |
Consider carrying out tests in primary care [1.5.3] Measure serum CA125 in primary care [1.5.6] See the section on primary care investigations for information on tests for ovarian cancer These recommendations apply to women aged 18 and over |
Weight loss with diarrhoea or back pain or abdominal pain or nausea or vomiting or constipation or new‑onset diabetes, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Weight loss with raised platelet count or nausea or vomiting, 55 and over |
Oesophageal or stomach |
Consider non-urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Primary care investigations
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Anaemia (iron‑deficiency) |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Anaemia (non-iron-deficiency), 60 and over |
Colorectal |
Offer quantitative faecal immunochemical testing [1.3.1] |
Blood glucose levels high with visible haematuria in women 55 and over |
Endometrial |
Consider a direct access ultrasound scan [1.5.12] |
Diabetes (new‑onset) with weight loss, 60 and over |
Pancreatic |
Consider an urgent direct access CT scan (to be done within 2 weeks), or an urgent ultrasound scan if CT is not available [1.2.5] |
Haemoglobin levels low with visible haematuria in women 55 and over |
Endometrial |
Consider a direct access ultrasound scan [1.5.12] |
Haemoglobin levels low with upper abdominal pain, 55 and over |
Oesophageal or stomach |
Consider non-urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Hypercalcaemia or leukopenia and presentation consistent with possible myeloma, 60 and over |
Myeloma |
Offer very urgent protein electrophoresis and a Bence–Jones protein urine test (within 48 hours) [1.10.5] |
Plasma viscosity or erythrocyte sedimentation rate and presentation consistent with possible myeloma |
Myeloma |
Consider very urgent protein electrophoresis and a Bence–Jones protein urine test (within 48 hours) [1.10.6] |
Platelet count raised with nausea or vomiting or weight loss or reflux or dyspepsia or upper abdominal pain, 55 and over |
Oesophageal or stomach |
Consider non‑urgent direct access upper gastrointestinal endoscopy [1.2.3] [1.2.9] |
Prostate‑specific antigen levels above the age‑specific threshold in table 1 plus lower urinary tract symptoms such as nocturia, urinary frequency, hesitancy, urgency or retention or erectile dysfunction or visible haematuria |
Prostate |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.3] |
Protein electrophoresis suggests myeloma |
Myeloma |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.10.7] |
Serum CA125 results |
Ovarian |
If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis [1.5.7] Normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound: assess her carefully for other clinical causes of her symptoms and investigate if appropriate if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent. [1.5.9] These recommendations apply to women aged 18 and over |
Thrombocytosis, 40 and over |
Lung |
Consider an urgent chest X‑ray (to be done within 2 weeks) [1.1.3] |
Thrombocytosis with visible haematuria or vaginal discharge (unexplained) in women 55 and over |
Endometrial |
Consider a direct access ultrasound scan [1.5.12] |
White cell count raised on a blood test with unexplained non‑visible haematuria, 60 and over |
Bladder |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.4] |
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Dermoscopy suggests melanoma of the skin |
Melanoma |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.7.2] |
Examination findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Prostate feels malignant on digital rectal examination |
Prostate |
Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.6.1] |
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Occult blood in faeces |
Colorectal |
Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.3.2] |
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Chest X‑ray suggests lung cancer |
Lung |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.1.1] |
Chest X‑ray suggests mesothelioma |
Mesothelioma |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.1.4] |
Ultrasound suggests ovarian cancer |
Ovarian |
Make an urgent referral for further investigation [1.5.8] These recommendations apply to women aged 18 and over |
Ultrasound normal with CA125 of 35 IU/ml or greater |
Ovarian |
Assess carefully for other clinical causes of her symptoms and investigate if appropriate If no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent [1.5.9] These recommendations apply to women aged 18 and over |
Ultrasound suggests soft tissue sarcoma or is uncertain and clinical concern persists in adults |
Soft tissue sarcoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.11.5] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
X‑ray suggests the possibility of bone sarcoma in adults |
Bone sarcoma |
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.11.1] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Jaundice, 40 and over |
Pancreatic |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.2.4] |
Investigation findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Bence–Jones protein urine results suggest myeloma |
Myeloma |
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) [1.10.7] |
Symptoms in children and young people
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Hepatosplenomegaly (unexplained) in children and young people |
Leukaemia |
Refer for immediate specialist assessment [1.10.2] |
Abdominal mass (palpable) or enlarged abdominal organ (unexplained) in children |
Neuroblastoma or Wilms' tumour |
Consider very urgent referral (for an appointment within 48 hours) for specialist assessment [1.12.1] [1.12.3] |
Splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Petechiae (unexplained) in children and young people |
Leukaemia |
Refer for immediate specialist assessment [1.10.2] |
Bleeding or bruising (unexplained) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Lymphadenopathy (generalised) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Lump (unexplained) that is increasing in size in children and young people |
Soft tissue sarcoma |
Consider a very urgent direct access ultrasound scan (to be done within 48 hours) [1.11.6] See the section on primary care investigations for more information on ultrasound scans Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
See also the section on abdominal symptoms for abdominal mass or unexplained enlarged abdominal organ, splenomegaly and hepatosplenomegaly.
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Newly abnormal cerebellar or other central neurological function in children and young people |
Brain or central nervous system cancer |
Consider a very urgent referral (for an appointment within 48 hours) [1.9.2] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Shortness of breath with lymphadenopathy in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Shortness of breath with splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Bone pain (persistent or unexplained) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Bone pain (unexplained) in children and young people |
Bone sarcoma |
Consider a very urgent direct access X‑ray (to be done within 48 hours) [1.11.3] See the section on primary care investigations for more information on X‑rays |
Bone swelling (unexplained) in children and young people |
Bone sarcoma |
Consider a very urgent direct access X‑ray (to be done within 48 hours) [1.11.3] See the section on primary care investigations for more information on X‑rays |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Petechiae (unexplained) in children and young people |
Leukaemia |
Refer for immediate specialist assessment [1.10.2] |
Bruising (unexplained) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Pallor in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Haematuria (visible and unexplained) in children |
Wilms' tumour |
Consider very urgent referral (for an appointment within 48 hours) for specialist assessment [1.12.3] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Fatigue (persistent) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Fever with lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Fever with splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Fever (unexplained) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Infection (unexplained and persistent) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Lymphadenopathy (generalised) in children and young people |
Leukaemia |
Offer a very urgent full blood count (within 48 hours) [1.10.3] |
Night sweats with lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Night sweats with splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Pruritus with lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Pruritus with splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Weight loss with lymphadenopathy (unexplained) in children and young people |
Non‑Hodgkin's lymphoma or Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment in children and young people. When considering referral, take into account any associated symptoms [1.10.9] [1.10.11] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Weight loss with splenomegaly (unexplained) in children and young people |
Non‑Hodgkin's lymphoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. When considering referral, take into account any associated symptoms [1.10.9] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
Examination findings and specific features |
Possible cancer |
Recommendation |
---|---|---|
Absent red reflex in children |
Retinoblastoma |
Consider urgent referral (for an appointment within 2 weeks) for ophthalmological assessment [1.12.2] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Parental or carer insight, concern or anxiety about the child's or young person's symptoms (persistent) |
Childhood cancer |
Take into account the insight and knowledge of parents and carers when considering making a referral for suspected cancer in a child or young person Consider referral for children if their parent or carer has persistent concern or anxiety about the child's symptoms, even if the symptoms are most likely to have a benign cause [1.13.1] |
Symptom and specific features |
Possible cancer |
Recommendation |
---|---|---|
Ultrasound scan suggests soft tissue sarcoma or is uncertain and clinical concern persists in children and young people |
Soft tissue sarcoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment [1.11.7] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |
X‑ray suggests the possibility of bone sarcoma in children and young people |
Bone sarcoma |
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment [1.11.2] Separate recommendations have been made for adults and for children and young people to reflect that there are different referral pathways. In practice young people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements |