Suspected cancer: recognition and referral NICE guideline. Published: 23 June 2015

Guideline based on symptoms 

Recommendations, such as US/FBC/CXR within 48hr, 2 week wait referral, or direct access ultrasound/CT/OGD further investigation in primary care, are based on symptoms (organ-specific, non-specific) and results of primary care investigations.

Organ-specific symptoms: abdominal, bleeding, musculoskeletal, neurological, skin or surface, lumps or masses, gynaecological, urological, oral, respiratory, pain

Non-specific symptoms: weight loss, appetite loss, DVT, diabetes, fatigue, fever, night sweats

Primary care investigations: anaemia, CA-125, CXR, FOB (FIT), thrombocytosis, ESR/PV, ultrasound

Threshold for cancer referral

The guideline uses a 3% PPV threshold value to underpin the recommendations for suspected cancer pathway referrals and urgent direct access investigations, such as brain scanning or endoscopy.

Guideline recommendations for children and young people were set below the 3% PPV threshold.

Safety Netting

The active monitoring in primary care of people who have presented with symptoms by:

1. Timely review and action after investigations. Be aware of the possibility of false‑negative results for chest X‑rays and tests for occult blood in faeces.

2. Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action. The review may be a planned future appointment OR patient‑initiated if symptoms persist or new symptoms develop.

Non‑site‑specific symptoms

Weight loss: many cancers (gastrointestinal, lung, prostate, pancreatic and urological)

Appetite loss: many cancers (gastrointestinal, lung, prostate, pancreatic and urological)

Deep vein thrombosis: many cancers (urogenital, breast, colorectal and lung cancer)