Scottish referral guidelines for suspected cancer: quick reference guide

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


Soft tissue mass with one or more of the following:

  • Size >5 cms.
  • Increasing in size.
  • Deep to fascia, fixed or immobile, regardless of size.
  • Painful (soft tissue sarcomas often painless).
  • Recurrence after previous excision.

Bone Cancer

X-ray if unexplained bone pain of:

  • Increasing severity or
  • persistent or
  • tender or
  • non-mechanical bone pain particularly disturbing rest or sleep.
  • If symptoms persist but x-ray is normal, repeat x-rays and consider referral.
  • Spontaneous or minor trauma fracture should raise suspicion of bone cancer.

Further causes of bone pain in older adults include metastases, myeloma and lymphoma.

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