About these guidelines

We have developed Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:


Non urgent

Non urgent

Requires routine referral or tests.


Urgent

Urgent

Required within two weeks.


Very urgent

Very urgent

Required within 48 hours.


Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Cervical cancer referral guidelines

Very urgent

Urgent referral


Consider urgent referral (appointment within two weeks) if the appearance of the woman’s cervix is consistent with cervical cancer.

Accompanying notes

A smear test is not required before referral, and a previous negative result should not delay referral.

Endometrial cancer referral guidelines

Non urgent

Urgent referral


Urgently refer women (appointment within two weeks) if they are aged 55 and over with postmenopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped due to the menopause).

Consider urgently referring (appointment within two weeks) women aged under 55 with postmenopausal bleeding.

Direct access ultrasound

Consider direct access ultrasound in women aged 55 and over with unexplained symptoms of vaginal discharge who:

  • are presenting with these symptoms for the first time
  • OR have thrombocytosis
  • OR report haematuria.

Consider direct access ultrasound in women aged 55 and over presenting with visible haematuria and any of the following:

  • low haemoglobin
  • thrombocytosis
  • high blood glucose level.

Ovarian cancer referral guidelines

Very urgent

Urgent referral


Urgently refer (appointment within two weeks) if physical examination identifies any of the following:

  • ascites
  • pelvic or abdominal mass (which is not obviously uterine fibroids).
Very urgent

Urgent investigation


Arrange CA125 and/or ultrasound tests in women (especially if 50 or over) who persistently or frequently (particularly more than 12 times per month) experience the following:

  • persistent abdominal distension (bloating)
  • early satiety and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • new onset symptoms suggestive of IBS (as IBS rarely presents for the first time in women of this age).

Consider CA125 and/or ultrasound tests if a woman reports any of the following:

  • unexplained weight loss
  • fatigue
  • changes in bowel habit (though colorectal cancer is a more common malignant cause).

Ovarian cancer referral flowchart

Vagina cancer referral guidelines

Non urgent

Urgent referral


Consider urgently referring (appointment within two weeks) women with an unexplained palpable mass in or at the entrance to the vagina.

Vulval cancer referral guidelines

Very urgent

Urgent referral


Consider urgently referring (appointment within two weeks) women with any of the following unexplained vulval signs or symptoms:

  • a vulval lump
  • ulceration
  • bleeding.

Glossary

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years
  • Young people – people aged 16–24
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks).