Scottish Referral Guidelines for Suspected Cancer
Scottish Referral Guidelines Infographic
Save our SRG body infographic which summarises the cancer referral guidelines on one page.
The Scottish Referral Guidelines (SRG) for Suspected Cancer support healthcare professionals to recognise people with signs and symptoms of suspected cancer and refer them promptly for specialist investigation.
The guidelines were updated in June 2025 to align with the latest evidence. Access the full SRG to support your practice.
On one page, we cover all the symptoms which warrant urgent referral for you to quickly reference in practice.
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Why are referral guidelines important?
Referral guidelines based on high-quality clinical evidence support healthcare professionals in their decision making and optimise referrals from primary care. By facilitating prompt recognition and referral, guidelines could reduce the proportion of cancers diagnosed via emergency presentation, which are associated with worse outcomes [1].
The use of national cancer referral guidelines varies [2]. Increased use of guidelines has been shown to have a positive impact on time to diagnosis. For example, research into chest-imaging guideline compliance found that the time between initial presentation and lung cancer diagnosis was longer for people who did not receive chest x-ray in line with the guidelines [3].
Top tips to support timely recognition and referral of suspected cancer
| Use national guidelines alongside your clinical judgement | Your clinical judgement and gut-feeling are key tools to support prompt recognition and referral of suspected cancer. Use national and local guidelines to support your practice. | |
| Use available investigations to aid your decision-making | Check which investigations are recommended in referral guidelines to prioritise your actions. Chest X-rays, CT scans and blood tests are usually accessible and may help support clinical assessment. If you’re unsure of what’s available to you, contact your practice or Health Board. | |
| Investigate non-specific symptoms | Consider referral to a Rapid Cancer Diagnostic Service (RCDS) or request direct access to CT for people with unexplained, non-specific symptoms that could be caused by cancer. Our non-specific symptoms webpage has more information about Scottish pathways and practical tips. | |
| Get advice if you’re not sure of the best action to take | If you’re not sure whether an urgent suspicion of cancer referral is the right action, use available services to seek advice and guidance from secondary care or talk to your colleagues. | |
| Effectively communicate with patients about their referral | Explain to patients that they’re being referred on an urgent suspicion of cancer pathway and ask them if they have any questions. Let them know what to expect at their next appointment and communicate the importance of attending. Use our ‘Your Suspected Cancer Referral Explained’ resource to support your conversations. | |
| Implement robust safety netting | Safety netting is vital for all patients, including those who’ve been referred to secondary care. For people who are managed in primary care, continue to support or investigate until symptoms are explained or resolved. Ensure safety netting systems are set up, actions are recorded and referrals are coded appropriately. Remember to act on clinical suspicion or ‘gut feeling’ if you still have concerns. See our safety netting webpage for more information and resources. |
How did Cancer Research UK support the 2025 update to the SRG?
We’re proud to have supported the 2025 updated to the SRG. We were asked by the Centre for Sustainable Delivery (CfSD) in Scotland to provide evidence and insights to support their clinical review.
We conducted 16 rapid literature reviews to cover all cancer sites included in the guidelines. We presented our key findings at peer review sessions to experts in the field, where initial decisions about guideline changes were made for each cancer site. We also completed evidence reviews on non-specific symptoms and wider referral guideline considerations (eg the impact of risk thresholds).
Alongside peer-reviewed literature, we triangulated a range of insights from Cancer Research UK’s regular survey programmes, a bespoke survey of Scottish GPs, conversations with relevant stakeholders and commissioned qualitative research investigating factors impacting guideline use.
To find out more about this process, get in touch.
References
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Neal RD, Smith G. Urgent cancer referrals: how well are they working and can they be improved? British Journal of General Practice. 2021.