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.


Oesophago-Gastric, Hepatobiliary and Pancreatic Cancers

Oesophago-gastric cancer

Urgent suspicion of cancer referral

  • Dysphagia (interference of the swallowing mechanism that occurs within five seconds of the swallowing process) or unexplained odynophagia (pain on swallowing) at any age
  • Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
  • new or worsening upper abdominal pain or discomfort
  • unexplained iron deficiency anaemia
  • reflux symptoms
  • dyspepsia resistant to treatment
  • vomiting
  • New vomiting persisting for more than two weeks

Hepatobiliary and pancreatic cancer

Urgent suspicion of cancer referral

  • Painless obstructive jaundice
  • Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
  • upper abdominal or epigastric mass
  • new onset diabetes
  • any suspicious abnormality, in the hepatobiliary tract, found on imaging (such as biliary dilatation or pancreatic/liver lesion)
  • new onset, unexplained back pain (consider other cancer causes including myeloma or malignant spinal cord compression)
  • ongoing GI symptoms despite negative endoscopic investigations

Oesophago-gastric cancer

Good practice points

Consider routine referral for people presenting with new upper gastrointestinal pain or discomfort combined with any of the following risk factors:

  • family history of oesophago-gastric cancer in a first-degree relative
  • Barrett’s oesophagus
  • pernicious anaemia
  • previous gastric surgery
  • achalasia (dysfunction of the oesophageal muscle)
  • known dysplasia, atrophic gastritis or intestinal metaplasia

Primary care management

  • Dyspepsia without accompanying symptoms or risk factors should be managed according to local or national guidelines

Hepatobiliary and pancreatic cancer

Good Practice Points

  • Consider seeking advice in people presenting with new onset GI symptoms with known chronic liver disease

There is emerging evidence that thrombocytosis is a risk marker for underlying cancer, including gastric and oesophageal. Remember “LEGO-C”.

Contact

Email: Cancer Access Team

Back to top