Urgent Suspected Upper GI Cancer

Who to refer:

• Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
  • New or worsening upper abdominal pain or discomfort
  • Unexplained iron deficiency anaemia
  • Reflux symptoms
  • Dyspepsia resistant to treatment
  • Vomiting
• New vomiting persisting for more than two weeks

• Please remember that all patients with dysphagia should be urgently (USoC) referred to upper GI for upper GI endoscopy using the specific Dysphagia referral pathway.

How to refer:

Referral is via SGI Gateway to RIE, SJH and WGH using the GI Upper excl Dysphagia referral pathway:

• RIE >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)
• SJH >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)
• WGH >> Gastroenterology – Medical >> LI GI Upper excl Dysphagia (priority USOC)

PLEASE REMEMBER THAT THIS REFERRAL PATHWAY IS USED FOR ALL UPPER GI REFERRALS (excluding Dysphagia) AND SO THE PRIORITY OF USOC NEEDS TO BE SELECTED FOR ALL USOC REFERRALS.

Regardless of the hospital referred to patients may be contacted to offer an appointment at a different site. If there are specific reasons that a patient would not be suitable for this, please make sure this information is included in the referral.

It is helpful if at the time of referral, the referrer informs the patient that they may be offered an appointment at a different site.

What Information should be included:

Protocol Text Tab

The protocol text tab asks a number of specific questions based on the Scottish Cancer Referral Guidelines. The answers to these questions help the Gastrointestinal team to triage referrals appropriately. This is very important for USOC referrals especially.

Questions for all patients

• Age: < 40 years / 40-55 years / > 55 years
• Duration of symptoms: Unknown / < 1 month / 1-3 months / 3-6 months / > 6 months
• Unexplained weight loss (greater than 5% of body weight): Yes / No

Questions for patients with unexplained weight loss

• New or worsening upper abdominal pain or discomfort: Yes / No
• Reflux: Yes / No
• Dyspepsia resistant to treatment: Yes / No
• Vomiting: Yes / No

Questions for all patients

• New persistent vomiting for more than 2 weeks: Yes / No
• Epigastric Mass: Yes / No
• Significant Haematemesis: Yes / No
• Melaena: Yes / No
• Current NSAID use: Yes / No
• Fe-deficiency anaemia: Yes / No

• Previous GI investigations: Details to be written into free text box

• Key Information for endoscopy (e.g. anticoagualation, prosthetic heart valve, diabetic on insulin, severe comorbidity): Yes / No (and a request to provide details under the Referral Text Tab

Information to include in referral under Referral Text Tab

• Further clinical history relevant to referral
• Details of any key information required for endoscopy
• Any information on comorbidities and frailty, including (if appropriate) a Frailty score

• Hoarse voice (consider ENT referral).
• Coexisting iron deficiency anaemia.
• Coughing / choking during or after drinking.
• Progressive dysphagia particularly for solids.
• Regurgitation.

PLEASE REMEMBER THAT THIS REFERRAL PATHWAY IS USED FOR ALL UPPER GI REFERRALS (excluding Dysphagia) AND SO THE PRIORITY OF USOC NEEDS TO BE SELECTED FOR ALL USOC REFERRALS.

After Referral

• GI will triage referral, usually to urgent upper endoscopy (USoC) at any of the 5 Lothian sites. Patients may also be offered appointments at the Regional Endoscopy Unit (REU) at QMH, Dunfermline, where NHS Lothian endoscopists also undertake lists.
• For patients who may struggle to tolerate upper endoscopy, or may not be fit enough for this, please give some indication of this in the referral free text
• If a patient might require urgent admission to hospital, please contact (via switchboard) the on-call GI Registrar (ST) at RIE/WGH or on-call medical team at SJH

Scottish Cancer Referral Guidelines – Upper GI Pathways