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'Referral advice' recommendation details

Referral for suspected cancer

Results 41-50 of 53

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG27 The primary healthcare professional should request thyroid function tests in patients with a thyroid swelling without stridor, or without any of the following features: - a solitary nodule increasing in size - a history of neck irradiation - a family history of an endocrine tumour - unexplained hoarseness or voice changes - cervical lymphadenopathy - very young (pre-pubertal) patients - patients aged 65 years and older. Patients with hyper- or hypothyroidism and an associated goitre are very unlikely to have thyroid cancer and could be referred, nonurgently, to an endocrinologist. Those with goitre and normal thyroid function tests who do not have any of the features indicated above, should be referred non-urgently. Initiation of other investigations by the primary healthcare professional, such as ultrasonography or isotope scanning, is likely to result in unnecessary delay and is not recommended. Time frame not specified
CG27 In patients aged less than 55 years, endoscopic investigation of dyspepsia is not necessary in the absence of alarm symptoms. These include for example: - chronic gastrointestinal bleeding - dysphagia - progressive unintentional weight loss - persistent vomiting - iron deficiency anaemia - epigastric mass - suspicious barium meal result. Time frame not specified
CG27 In patients with suspected upper gastrointestinal cancer presenting with dysphagia (interference with the swallowing mechanism that occurs within 5 seconds of having commenced the swallowing process), an urgent referral should be made. Urgent
CG27 In suspected upper gastrointestinal cancers, helicobacter pylori status should not affect the decision to refer. Urgent
CG27 A patient who presents with symptoms suggestive of upper gastrointestinal cancer should be referred to a team specialising in the management of upper gastrointestinal cancer, depending on local arrangements. Urgent
CG27 In suspected upper gastrointestinal cancer, patients with obstructive jaundice should be referred urgently depending on the patient's clinical state. An urgent ultrasound investigation may be considered if available. Urgent
CG27 In patients with unexplained worsening of their dyspepsia, an urgent referral should be considered if they have any of the following known risk factors: - Barrett's oesophagus - known dysplasia, atrophic gastritis or intestinal metaplasia - peptic ulcer surgery more than 20 years ago. Patients being referred urgently for endoscopy should ideally be free from acid suppression medication, including proton pump inhibitors or H2 receptor antagonists, for a minimum of 2 weeks. In patients where the decision to refer has been made, a full blood count may assist specialist assessment in the outpatient clinic. This should be carried out in accordance with local arrangements. All patients with new-onset dyspepsia should be considered for a full blood count in order to detect iron deficiency anaemia. Urgent
CG27 An urgent referral for endoscopy or to a specialist with expertise in upper gastrointestinal cancer should be made for patients of any age with dyspepsia who present with any of the following: - chronic gastrointestinal bleedingm - dysphagia - progressive unintentional weight loss - persistent vomiting - iron deficiency anaemia - epigastric mass - suspicious barium meal result. Urgent
CG27 In patients without dyspepsia, but with unexplained weight loss or iron deficiency anaemia, the possibility of upper gastrointestinal cancer should be recognised and an urgent referral for further investigation considered. Urgent
CG27 In patients with persistent vomiting and weight loss in the absence of dyspepsia, upper gastro-oesophageal cancer should be considered and, if appropriate, an urgent referral should be made. Urgent

This page was last updated: 22 August 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.