upper GI cancer (NICE guidance - urgent referral for suspected cancer)

Last edited 09/2019 and last reviewed 12/2022

Suspected Oesophageal cancer

• offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer n people:
  • with dysphagia or
  • aged 55 and over with weight loss and any of the following:
    • upper abdominal pain
    • reflux
    • dyspepsia

Suspected Stomach cancer

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer
• offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for stomach cancer in people:
  • with dysphagia or
  • aged 55 and over with weight loss and any of the following:
    • upper abdominal pain
    • reflux
    • dyspepsia

Suspected Gall bladder cancer

• consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder

Suspected Liver cancer

• consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for liver cancer in people with an upper abdominal mass consistent with an enlarged liver

Suspected Pancreatic cancer

• refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for pancreatic cancer if they are aged 40 and over and have jaundice

  Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following:

  • diarrhoea
  • back pain
  • abdominal pain
  • nausea
  • vomiting
  • constipation
  • new-onset diabetes

Non Urgent Referral guidance:

Suspected stomach cancer/oesophageal cancer:

• consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people with haematemesis
  
  
• consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer/oesophageal cancer in people aged 55 or over with:
  • treatment-resistant dyspepsia or
    
    
  • upper abdominal pain with low haemoglobin levels or
    
    
  • raised platelet count with any of the following:
    • nausea
    • vomiting
    • weight loss
    • reflux
    • dyspepsia
    • upper abdominal pain, or
      
      
  • nausea or vomiting with any of the following:
    • weight loss
    • reflux
    • dyspepsia
    • upper abdominal pain

Reference:

1. NICE (June 2015). Referral Guidelines for Suspected Cancer.