NICE guidance is that there are a lot of symptoms which require the urgent exclusion of cancer. People with these symptoms should be referred urgently by their GP and seen within 2 weeks. (COVID has meant many hospitals struggle to hit the 2 week target, but the wait should still be short). NICE Guidance covers all cancers.  The reality is that even if you have some of these symptoms only about 7-8 in 100 people will have cancer, so nearly 19 out of 20 won’t.

In general, all GPs should follow NICE guidance.

I have tried to use clear language to explain, but the guidance is taken directly from NICE where you can find more detail. They give advice by part of the body and by symptom

One of the terms that NICE uses a lot is dyspepsia. They define it as follows: 

“The term 'dyspepsia' is used to describe a complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting.”

So really, it is what the public would call indigestion.

These are the urgent symptoms relevant to heartburn and reflux

• Dysphagia, which is difficulty swallowing or food sticking at any age.
• Weight loss over 55 yrs old, with at least one of reflux, pain in the upper part of your tummy, or general indigestion (dyspepsia)
• Any lump found in the upper part of your tummy which could be stomach, liver or gallbladder.

NICE also lists symptoms that are regarded as reasons to refer but less urgently

• Anyone who vomits blood (haematemesis)
• People over 55 with:
  1. Dyspepsia that does not respond to treatment
  2. Upper tummy pain and low blood count (anaemia)
  3. Raised platelet count (these are the cells in your blood involved with clotting blood) and also any of the following: nausea, vomiting, weight loss, reflux, dyspepsia or upper tummy pain
  4. Nausea or vomiting and also any of the following: weight loss, reflux, dyspepsia or upper tummy pain

As you can see the guidance is quite specific and in many cases related to over 55 years old. To follow the guidance patients would usually need some blood tests and an examination.

NICE also says: Use the guidelines to guide referrals. If still uncertain about whether a referral is needed, consider contacting a specialist.  (Almost all hospitals offer GPs advice and guidance, where they can e-mail specialists with a patient details and get advice about appropriate care.) Consider a review for people with any symptom associated with increased cancer risk who do not meet the criteria for referral or investigative action.

GPs are also encouraged to use “gut feeling” and concern and can refer outside NICE guidance.

My next blog will look at the guidance for people who do not fit the cancer pathway and what NICE says about how dyspepsia should be managed, particularly in those under 55  and when referral is appropriate.  This may be particularly relevant to patients who feel their symptoms are not being taken seriously enough.