Publication - Advice and guidance

Scottish referral guidelines for suspected cancer: quick reference guide

User-friendly visual aid to the urgent referral criteria as well as routine referral criteria and primary care management and good practice points.

Emergency (same day) referral

Headache

Urgent suspicion of cancer referral

Neurological deficit	Progressive neurological deficit (including personality, cognitive or behavioural change) in the absence of previously diagnosed or suspected alternative disorders (such as multiple sclerosis or dementia)
Seizure	Any new seizure Seizures which change in character such as post–ictal deficit, headache, increased frequency, etc

Good practice points

Consider urgent investigation/referral for patients with non-migrainous headaches of recent onset, when accompanied by ‘red flag’ features suggestive of raised intra cranial pressure (for example: woken by headache; vomiting; drowsiness), progressive neurological deficit or new seizure disorder
All NHS Boards have pathways for investigation of headaches which should include primary care direct access to imaging
If any uncertainty about the presence of papilloedema, the person should be urgently referred to an optometrist for assessment. If there are red-flags suspicious of cancer as detailed above, a simultaneous urgent suspicion of cancer referral to secondary care should be made. If papilloedema is confirmed, the optometrist should refer directly to secondary care
An urgent, suspicion of cancer pathway should exist in all NHS Boards for optometrists to refer directly to secondary care for people with optic discs suspicious of papilloedema

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