HNY Policy and Pathway Repository - Humber

These forms are only to be used for referrals with a high risk of cancer.  To assist you in evaluating the potential risk for cancer the QCancer Assessment can be beneficial. QCancer has been developed for the UK with risk algorithms.  This tool will only provide a level of risk of cancer and is not a diagnosis tool.

• Dysphagia or
• An upper abdominal mass consistent with a gastric malignancy or
• Aged 55 and over with weight loss and any of the following:
  • Upper abdominal pain
  • Reflux
  • Dyspepsia

Exclude red flag symptoms

• Haematemesis and/or melena with cardiovascular compromise

DO NOT REFER

• Iron deficiency anaemia (low Hb +/- microcytosis and low ferritin) with;
• Positive coeliac screen (Anti t-Tg) – refer to medical gastroenterology
• Urine dipstick positive for blood, in the absence of symptoms suggesting gastrointestinal disease – arrange USS renal tract and refer to urology
• All premenopausal women with IDA should be screened for coeliac disease, but GI investigation should be reserved for those aged 50 years or older, those with symptoms suggesting gastrointestinal disease, and those with a strong family history of colorectal cancer

Iron deficiency anaemia with no obvious cause refer to medical gastroenterology for further investigation

Presenting Symptoms for Non-Urgent Endoscopy

Consider non-urgent direct access upper gastrointestinal endoscopy in people with:

• Haematemesis

Consider non-urgent direct access upper gastrointestinal endoscopy 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

• Dysphagia of any age or;
• Aged ≥55 and over with significant and concerning weight loss and any of the following:
  • Upper abdominal pain/ or
  • Reflux
  • Dyspepsia
  • Thrombocytosis
• Upper abdominal mass consistent with gastric cancer
• Abnormal barium or radiological study suggesting oesophago-gastric cancer

The Central Referral Point telephone number is: 01482 604308

Electronic referrals can be made via the NHS e-Referral system. Services for a 2 week wait, suspected cancer are found by searching on speciality for 2ww and then selecting the clinic type i.e. 2ww Upper GI.

• Medical History / Drugs / Allergies
• Patient weight (in KGs)
• Recent FBC, U&E, LFT, Ferritin, B12, Folate and Anti t-Tg (ideally within the last 8 weeks)
• The WHO performance status classification of the patient;

0: Able to carry out all normal activity without restriction

1: Restricted in strenuous activity but ambulatory and able to carry out light work

2: Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours

3: Symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden

4: Completely disabled; cannot carry out any self-care; totally confined to bed or chair.

• If weight significant and concerning weight loss, the amount of weight lost (kgs) and duration of weight loss 

• 2WW Patient Information
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