This guideline covers identifying children, young people and adults with symptoms that could be caused by cancer. It outlines appropriate investigations in primary care, and selection of people to refer for a specialist opinion. It aims to help people understand what to expect if they have symptoms that may suggest cancer.

We have used the terms 'men' and 'women' in some recommendations on gender-related cancers, but they also apply to people who have changed or are in the process of changing gender, and who retain the relevant organs.

In October 2023, we updated recommendations on suspected cancer pathway referrals in line with NHS England’s standard on faster diagnosis of cancer. People should have a diagnosis or ruling out of cancer within 28 days of referral.


This guideline includes recommendations on the symptoms and signs that warrant investigation and referral for suspected cancer.

The recommendations are organised by:

The guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • People involved in clinical governance in both primary and secondary care
  • People with suspected cancer and their families and/or carers

Is this guideline up to date?

May 2024: We will update the ovarian cancer section of the guideline following a review of the NHS England (NHSE) National Cancer Programme (NCP) tumour site review to identify opportunities for improving earlier diagnosis. For more information, see the surveillance decision

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces NICE guideline CG27 (June 2005) and updates and replaces recommendations in NICE guideline CG121 (April 2011).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.