Scottish referral guidelines for suspected cancer: quick reference guide

Haematological Cancers

Urgent suspicion of cancer referral

• Blood count/film reported as suggestive of acute leukaemia or chronic myeloid leukaemia*
• Lymphadenopathy (>2cm) persisting for six weeks or increasing in size or generalised (HIV status should always be checked if generalised)
• Hepatosplenomegaly in the absence of known liver disease
• Bone pain associated with a paraprotein and/or anaemia
• Bone x-rays reported as being suggestive of myeloma
• The following clinical features may also merit urgent referral:
• fatigue
• night sweats
• weight loss
• itching
• bruising
• recurrent infections
• bone pain
• polyuria and polydipsia (hypercalcaemia)

*will normally be identified in the laboratory and communicated to the clinician for management to be agreed.

Good practice points

• For people presenting with non-specific symptoms, the clinician should always consider checking human immunodeficiency virus (HIV) status along with other routine investigations
• Routine tests and investigations should be repeated at least once if a person’s condition remains unexplained
• If myeloma is suspected, urine as well as serum electrophoresis should be performed

Primary care management

• CLL in an older person should be discussed with a local haematologist but many cases do not require detailed haematological review
• Asymptomatic monoclonal gammopathy may be followed up in primary care depending on local arrangements – consider discussion with a haematologist if any concern