Suspected cancer: recognition and referral

Recognising, investigating and referring people with symptoms that might suggest cancer

Understanding cancer symptoms

There are many different types of cancer, with many different symptoms. Some symptoms affect a specific area of the body – such as a lump, pain, unusual bleeding, or a change in bowel or bladder habits – while others are more general, such as tiredness or weight loss.

Many other illnesses, which are much more common and less serious than cancer, can cause the same types of symptoms. This can sometimes make it difficult for healthcare professionals to spot cancer.

Suspected cancer referrals

This guideline helps GPs and other healthcare professionals working in primary care – such as dentists, nurses, physician assistants or opticians – to decide when to:

• offer initial tests
• make a referral to a hospital doctor (known as a specialist)
• monitor symptoms over time.

If you have symptoms or other problems that could be caused by cancer, the person referring you may offer to carry out some tests or refer you to a cancer specialist. This is a precaution – not a diagnosis. It doesn’t mean you have cancer – it’s a precaution to rule it out or catch it early. Early checks are important, as finding cancer sooner often makes treatment simpler and more effective.

The GP (or other healthcare professional) will decide what kind of tests or referral you might need, based on your symptoms.

If your symptoms suggest that you may have a higher chance of cancer, they may refer you through a suspected cancer pathway referral, with the aim of having a diagnosis or ruling out of cancer within 28 days of referral.

In rare cases – like fast‑developing symptoms or certain types of cancer – you might be seen even sooner.

Sometimes they may offer tests like X-rays or stool (poo) tests before you are referred.

In addition to suspected cancer pathway referrals, they may also make a routine referral if your symptoms are less concerning or don’t meet the criteria for an urgent pathway. A routine referral means you’ll be referred to a specialist for further assessment, but the waiting time is longer. This route is often used when symptoms are mild, non-specific, or more likely to be caused by non-cancerous conditions. While routine referrals are less time-sensitive, they’re still important for monitoring your health and ruling out serious issues. If your symptoms change or worsen while waiting, you should contact your GP surgery again, as they may upgrade your referral so you can be seen more urgently.

Your risk of cancer depends on more than just your symptoms—it also includes things like your age, smoking history, and other health factors. Even if 1 symptom seems low risk, it could be more serious when combined with others.

What happens if you're referred

Being referred for suspected cancer can be worrying. The person referring you should explain that most people who are referred will not have cancer. They should discuss any other conditions that may be causing the symptoms.

They should give you information about why you’re being referred and what may happen at the appointment. They should explain how you can get more information before your appointment and give you details of local and national support. The information you are given should be in a suitable format and language for you, and should take into account your cultural needs.

And finally, they should support you while you wait and inform the specialist of any personal circumstances that may affect your care.

If you are not referred but still concerned

If you have any symptom that could be caused by cancer but the person referring you thinks it is unlikely, they should explain that the risk of cancer is low, but that you should come back for another assessment if your symptoms change. They should explain to you what to look out for, such as other symptoms or changes to your current symptoms, and when you should return for another appointment.

They may also offer you an appointment to review your symptoms. This might be a planned appointment after a certain period of time or carried out when you return because of your symptoms (for example, if they continue, get worse or come back), if you develop new symptoms or if you are still worried.

Symptoms of cancer in children and young people

The types of cancer that affect children and young people can be can quite different from those in adults.

Cancer in children and young people is rare. It can be very difficult to spot because many of the symptoms are the same as those for less serious conditions. If your child has symptoms that you are concerned about, your healthcare professional should take into account your concerns and your knowledge of your child. Your child may be offered an appointment with a specialist (such as a paediatrician) if you continue to have concerns about their symptoms, even if it’s very unlikely that cancer is the cause.

What this guideline aims to achieve

We want this guideline to make a difference by making sure:  

• GPs and other healthcare professionals such as dentists, nurses or opticians working in primary care know what to look for—which symptoms should lead to tests, a routine referral to a specialist, or a suspected cancer pathway referral
• they have clear advice on which tests to use and when to use them
• people who have symptoms of cancer understand what’s happening, for example, why they’re being referred or why they have been offered a test, and what the next steps will be
• everyone receives timely, thorough care, with shared decision making.

Making decisions together

Decisions about treatment and care are best when they are made together. Your healthcare professional should give you clear information, talk with you about your options and listen carefully to your views and concerns.

To help you make decisions, you may want to ask:

About your symptoms

• Can you tell me more about my symptoms and what might be causing them?

Tests and investigations

• Can you tell me more about the tests or investigations you’ve offered me?
• What do these tests involve?
• Where will these be carried out? Will I need to have them in hospital?
• How long will I have to wait until I have these tests?
• How long will it take to get the results of these tests?

Referral to a cancer specialist

• Why have I been referred to a cancer specialist? Do I have cancer?
• What will happen at the appointment with the cancer specialist?
• What tests or investigations will I need?

Support and information

• I am really worried – where can I go to get some psychological support and more information?
• I haven’t been referred but I’m still worried – can I see someone else?
• Can you tell me what symptoms I should look out for that mean I need to come back for a review?
• Are there any support organisations in my local area?
• Can you provide any information for my family/carers?

For family members, friends or carers

• What can I (or we) do to help and support the person with suspected cancer?
• Is there any additional support that carer(s) might benefit from or be entitled to?

If you need more support to understand the information you are given, tell your healthcare professional.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about cancer.

• Cancer Research UK, 0808 800 4040
• Macmillan Cancer Support, 0808 808 00 00
• Teenage Cancer Trust, hello@teenagecancertrust.org

You can also find information about people’s experience on healthtalk.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people and staff who treat and support them. All the information is based on the best research available.

ISBN: 978-1-4731-7756-7