Lung

• Lung and pleural cancers (NICE, 2015)

Upper GI

• Weight loss in combination with other symptoms (e.g. dyspepsia, upper abdominal pain or reflux) does support a 2WW referral, but not weight loss alone

• NICE Clinical Knowledge Summaries. Gastrointestinal tract (upper) cancers - recognition and referral: Scenario: Referral for suspected gastrointestinal tract (upper) cancer. 

Lower GI

Faecal immunochemical test (FIT) for occult blood. If positive: urgent referral

Indications for FIT test:

• >50 with unexplained abdominal pain or weight loss

• <60 with change in bowel habit or iron deficiency anaemia

• >60 with anaemia in the absence of iron deficiency 

• Lower gastrointestinal tract cancers (NICE, 2015)

Breast

• Breast cancer (NICE, 2015)

Gynaecological

• Gynaecological cancers (NICE, 2015)

Urological

• Urological cancers (NICE, 2015)

Skin

• Skin cancers (NICE, 2015)

Head & neck

• Laryngeal ca 2WW: >45 & persistent unexplained hoarseness OR unexplained neck lump

• Oral ca 2WW: unexplained ulceration in the oral cavity >3W OR persistent and unexplained lump in the neck 

• Oral ca 2WW to dentist: lump on the lip or in the oral cavity OR a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

• Thyroid 2WW: unexplained thyroid lump 

• Head and neck cancers (NICE, 2015)

Brain/CNS

• Adults with progressive, sub‑acute loss of central neurological function: urgent brain MRI (or CT scan if MRI is contraindicated) 

• Children/young people with newly abnormal cerebellar or other central neurological function: very urgent referral (appointment within 48 hours)

• Brain and central nervous system cancers (NICE, 2015)

Haematological

• Haematological cancers (NICE, 2015)

Sarcoma

• Sarcomas (NICE, 2015

Children

You see a 9-year-old boy with Down’s syndrome. His mother reports that he has been more lethargic recently. On examination his temperature is 35.8°C and he has hepatosplenomegaly.

What is the SINGLE MOST appropriate management for this patient?

• Refer for urgent abdominal ultrasound

• Refer immediately to paediatrics (same-day admission)

• Refer routinely to paediatrics

• Refer urgently to paediatrics (within two weeks)

• Arrange an urgent full blood count

Refer immediately children or young people with unexplained petechiae or hepatosplenomegaly to exclude leukaemia. There is an increased risk of leukaemia in children with Down’s syndrome.

• Neuroblastoma: palpable abdominal mass or unexplained enlarged abdominal organ: V. urgent referral (within 48 hrs)

• Retinoblastoma: absent red reflex: urgent referral (within 2 weeks) for ophthalmological assessment

• Wilms' tumour: palpable abdominal mass OR unexplained enlarged abdominal organ OR unexplained visible haematuria: V. urgent referral (within 48 hrs)

• "immediate specialist assessment" is required in cases where the child has unexplained petechiae or hepatosplenomegaly

References

• NICE. Suspected cancer: recognition and referral. NG12. 2015 (updated 2023)

• Blood cancer (RCGP); Cancer in children and young people (RCGP)

Non-site-specific 

• Non‑site‑specific symptoms​​ (NICE, 2015)