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).

Bladder cancer referral guidelines

Very urgent

Urgent referral


Urgently refer people (appointment within two weeks) if they are:

  • aged 45 and over with either:
    • unexplained visible haematuria without urinary tract infection
    • OR visible haematuria that persists or recurs after successful treatment of urinary tract infection.
  • aged 60 or over with unexplained non-visible haematuria and either:
    • dysuria
    • OR a raised white cell count on a blood test.
Non urgent

Non urgent


Consider referring people aged 60 or over with recurrent or persistent urinary tract infection that is unexplained.

Penile cancer referral guidelines

Non urgent

Urgent referral


Consider urgent referral (appointment within two weeks) for men with any of the following (after a sexually transmitted infection has been ruled out as a cause, or they have completed treatment for an STI):

  • a penile mass
  • an ulcerated lesion
  • unexplained or persistent symptoms affecting the foreskin or glans.

Prostate cancer referral guidelines

Very urgent

Urgent referral


Urgently refer men (appointment within two weeks) if either:

  • their prostate feels malignant on digital rectal examination (DRE)
  • OR their prostate specific antigen (PSA) levels are above the age-specific reference range.
Non urgent

Non-urgent investigation


Consider a PSA test and DRE in men with any of the following:

  • any lower urinary tract symptoms, such as:
    • nocturia
    • urinary frequency
    • hesitancy
    • urgency or retention
    • erectile dysfunction
    • visible haematuria.

Accompanying notes

Prostate-specific antigen ranges:

  • 40–49 years 0–2.5ng/L
  • 50–59 years 0–3.5ng/L
  • 60–69 years 0–4.5ng/L
  • 70–79 years 0–6.5ng/L

Consider alternative contributing factors that may influence an individual’s PSA range.

Renal cancer referral guidelines

Non urgent

Urgent referral


Urgently refer people (appointment within two weeks) if they are aged 45 years or over with either:

  • unexplained visible haematuria without urinary tract infection
  • OR visible haematuria that persists or recurs after successful treatment of urinary tract infection.

Testicular cancer referral guidelines

Very urgent

Urgent referral


Consider urgent referral (appointment within two weeks) in men with any of the following changes in the testis:

  • non-painful enlargement
  • change in shape
  • change in texture.

Direct access ultrasound

Consider a direct access ultrasound scan for men with unexplained or persistent testicular symptoms.

Glossary

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).