Scottish referral guidelines for suspected cancer: quick reference guide

Scottish Referral Guidelines for Suspected Cancer is a quick reference guide for cancer referrals.

Children's Tumours

Abnormal blood count

  • If reported as requiring urgent further investigation.


  • Always an indication for urgent investigation.

Fatigue in a previously healthy child and associated:

  • Generalised lymphadenopathy.
  • Hepatosplenomegaly.

Bone Pain especially if:

  • Diffuse or involves the back.
  • Persistently localised at any site.
  • Requiring analgesia.
  • Limiting activity.

Lymphadenopathy if any of the following:

  • Non tender, firm/hard and >3 cms in maximum diameter.
  • Progressively enlarging.
  • Associated with other signs of general ill health, fever, weight loss.
  • Involves axillary nodes (no local infection or dermatitis) or supraclavicular nodes.
  • Mediastinal or hilar mass on CXR.

Headache if any following:

  • Increasing in severity or frequency.
  • Worse in the morning or causing early wakening.
  • Associated with vomiting.
  • Associated with neurological signs (e.g. squint, ataxia).
  • Associated with behavioural change or deterioration in school performance.

Soft Tissue Mass if any of the following:

  • Shows rapid or progressive growth.
  • Size >3 cms in maximum diameter.
  • Fixed or deep to fascia.
  • Associated with regional lymph node enlargement.
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