Rapid referral guidelines for upper gastrointestinal cancer

Access our referral guidelines for upper gastrointestinal cancer, including gall bladder, liver, pancreatic, and oesophageal and gastric cancer

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).

Gall bladder cancer referral guidelines

Very urgent

Urgent direct access


Consider an urgent direct access ultrasound scan (within two weeks) to assess for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder.

Liver cancer referral guidelines

Non urgent

Urgent direct access


Consider an urgent direct access ultrasound scan (within two weeks) to assess for liver cancer in people with an upper abdominal mass consistent with an enlarged liver.

Accompanying notes

Consider that 10% of pancreatic cancers are missed by abdomen ultrasounds, while tumours smaller than 3cm will not be visible using an ultrasound. An additional benefit of a CT scan is that it can determine what stage a cancer is at.

Oesophageal and gastric cancer referral guidelines

Very urgent

Urgent referral for endoscopy within two weeks


Urgently refer people:

  • of any age presenting with dysphagia (Gastric/Oesophageal)
  • OR aged 55 or over with weight loss
  • AND upper abdominal pain
  • OR reflux
  • OR dyspepsia (Gastric/Oesophageal).

Consider urgent referral (appointment within two weeks) for people with an upper abdominal mass consistent with stomach cancer (Gastric).

Non-urgent direct access endoscopy

Consider non-urgent direct access endoscopy for people of any age presenting with haematemesis (Gastric/Oesophageal) OR aged 55 or over with:

  • treatment resistant dyspepsia (Gastric/Oesophageal)
  • OR upper abdominal pain and low haemoglobin (Gastric/Oesophageal)
  • OR raised platelet count with any of the following:
    • nausea
    • vomiting
    • reflux
    • weight loss
    • dyspepsia
    • upper abdominal pain (Gastric/Oesophageal)
  • OR nausea or vomiting with any of the following:
    • weight loss
    • reflux
    • dyspepsia
    • upper abdominal pain (Gastric/Oesophageal).

Pancreatic cancer referral guidelines

Non urgent

Urgent direct access CT scan or an urgent ultrasound scan if CT scan is not available


Consider urgent direct access CT scan (within two weeks), or ultrasound scan if CT scan is not available, for people aged 60 or over displaying weight loss and any of the following:

  • diarrhoea back pain
  • abdominal pain
  • nausea/vomiting
  • constipation
  • new-onset diabetes.
Non urgent

Urgent referral


Urgently refer (appointment within two weeks) people aged 40 or over with jaundice.

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).