Guidelines and referral pathways in England
Guidelines and referral pathways in England
NICE NG12 (2015) provides recommendations for managing people with certain non-specific symptoms:
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Unexplained weight loss. This is a symptom of several cancers including colorectal, gastro‑oesophageal, lung, prostate, pancreatic and urological cancer.
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Unexplained appetite loss. This is a symptom of several cancers including lung, oesophageal, stomach, colorectal, pancreatic, bladder and renal cancer.
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Deep vein thrombosis, which is associated with several cancers including urogenital, breast, colorectal and lung cancer.
NICE NG12 advises GPs to take the following actions for these symptoms:
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For people with deep vein thrombosis (which is associated with several cancers including urogenital, breast, colorectal and lung cancer):
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Offer urgent investigation or a suspected cancer pathway referral.
Non-specific symptom pathways in England
Since NG12 was last updated, non-specific symptom pathways have been rolled out in parts of England. NHS England’s ambition was to achieve whole population coverage by March 2024.
NHS England published referral criteria, which state GPs can use pathways for the following scenarios:
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New unexplained and unintentional weight loss (either documented >5% in three months or with strong clinical suspicion)
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New unexplained constitutional symptoms of four weeks or more (less if very significant concern). Symptoms include loss of appetite, fatigue, nausea, malaise, bloating, new unexplained non-site-specific abdominal pain of four weeks or more (less if very significant concern), new unexplained, unexpected or progressive pain, including bone pain, of four weeks or more
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GP ‘gut feeling’ of cancer diagnosis
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Abnormal radiology suggesting cancer; not needing admission and not suitable for existing urgent cancer referral or cancer of unknown primary pathway.
The guidance also includes optional criteria, and the core filter function tests that should be completed prior to referral to a non-specific symptoms pathway.