abdominal pain - NICE urgent cancer referral guidance
Last edited 09/2020 and last reviewed 04/2022
Abdominal pain with weight loss (unexplained), 40 and over) - urgent cancer referral guidance
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Abdominal pain with weight loss (unexplained), 40 and over) | Colorectal | Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) |
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Abdominal pain (unexplained) with rectal bleeding in adults under 50) | Colorectal | Consider a suspected cancer pathway referral (for an appointment within 2 weeks) |
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Abdominal pain without rectal bleeding, 50 and over | Colorectal |
Offer testing for occult blood in faeces (faecal immunochemical testing) Check FBC |
Upper abdominal pain - urgent cancer referral guidance
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Upper abdominal pain with weight loss, 55 and over | Stomach or oesophageal | Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) |
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Upper abdominal pain with low haemoglobin levels or raised platelet count or nausea or vomiting, 55 and over | Oesophageal or stomach | Consider non-urgent direct access upper gastrointestinal endoscopy |
Abdominal or pelvic pain (persistent or frequent - particularly more than 12 times per month) in women, especially if 50 and over
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Abdominal or pelvic pain (persistent or frequent - particularly more than 12 times per month) in women, especially if 50 and over | Ovarian | Measure Ca-125 |
Abdominal pain with weight loss, 60 and over
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Abdominal pain with weight loss, 60 and over | Pancreatic | Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available |
Irritable bowel syndrome symptoms within the last 12 months in women 50 and over
| Symptom and Specific Features | Possible Cancer | Recommendation |
| Irritable bowel syndrome symptoms within the last 12 months in women 50 and over | Ovarian |
Carry out appropriate tests for ovarian cancer, because irritable bowel syndrome rarely presents for the first time in women of this age Measure serum CA125 in primary care |
Reference:
NICE urgent cancer referral guidance
NICE urgent cancer referral guidance (guidelines with respect to presenting symptoms and signs)