Executive summary
- Threshold: Referral is warranted if the Positive Predictive Value (PPV) is ≥3%.
- Safety Netting: Mandatory for all patients who do not meet 2WW criteria but have concerning symptoms. Document specific "return if" advice.
- FIT Testing: Now the primary gatekeeper for colorectal referrals (replacing symptoms-only referrals for many low-risk groups).
High-Yield Referral Criteria (Adults)
- Lung (Chest X-ray first):
- Offer CXR if: Age >40 AND unexplained: cough (>3w), fatigue, SOB, chest pain, weight loss, or appetite loss.
- Immediate 2WW (skip CXR): Age >40 with unexplained haemoptysis.
- Action: If CXR suggests cancer → 2WW. If CXR normal but high suspicion → CT Chest (or 2WW depending on local pathway).
- Upper GI (Oesophageal/Stomach):
- Dysphagia: Direct 2WW (any age).
- Weight loss + Age >55: PLUS one of: upper abdo pain, reflux, or dyspepsia → 2WW.
- Non-urgent: Haematinics/H.Pylori for isolated dyspepsia.
- Lower GI (Colorectal):
- FIT Test <10 µg/g: Usually rules out cancer (PPV <1%). Investigate other causes unless rectal mass present.
- Refer 2WW if: Positive FIT (≥10) OR Rectal Mass (examination mandatory) OR Anal ulceration.
- Note: Iron deficiency anaemia (Age >60) often triggers 2WW directly, but check local FIT pathway.
Direct Access Imaging
- Brain (MRI): Progressive headache, focal signs, or personality change.
- Pancreas (CT): Age >60 with weight loss AND (diarrhoea, back pain, abdo pain, nausea, new diabetes).
- Ovarian (Ca125 + US): Persistent bloating/distension (daily/frequent) in woman >50.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.