Referral criteria for non-site-specific pathways

Core referral criteria for non-specific symptoms

• New unexplained and unintentional weight loss (either documented >5% in three months or with strong clinical suspicion);
• New unexplained constitutional symptoms of four weeks or more (less if very significant concern). Symptoms include loss of appetite, fatigue, nausea, malaise, bloating;
• New unexplained vague abdominal pain of four weeks or more (less if very significant concern);
• New unexplained, unexpected or progressive pain, including bone pain, of four weeks or more;
• GP ‘gut feeling’ of cancer diagnosis – reasons to be clearly described at referral.
• Abnormal radiology suggesting cancer; not needing admission and not suitable for existing urgent cancer referral or cancer of unknown primary pathway;

Exclusion criteria for non-specific symptoms

• Patient has specific alarm symptoms warranting referral onto a single site-specific pathway (in line with NG12);
• Patient is too unwell or unable to attend as an outpatient or needs acute admission;
• Patient is more likely to have a non-cancer diagnosis suitable for another specialist pathway;
• Patient is currently being investigated for the same problem by another specialist team.

Optional referral criteria

Optional referral criteria are for Alliances to consider as part of expanded cohorts or to amend to meet local needs. These should be considered where patients also have other concerning signs of cancer.

• New and unexplained breathlessness for more than three weeks (not requiring admission and not due to heart failure, VTE, IHD, COPD or Chest infection);
• Unexplained thromboembolism (depending on local alternative pathways);
• Abnormal laboratory findings not explained by established or self-limiting disease and not needing admission (e.g. Significantly raised CRP and infection excluded, ALP >x2, raised calcium, platelets >400 men, or >450 women alongside other symptoms);
• Those who cannot wait for an urgent cancer referral pathway (if local RDC provision supports this) e.g. if attending A&E with symptoms that meet the referral criteria.