The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August 2025.
We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here https://www.gov.scot/publications/scottish-referral-guidelines-suspected-cancer-2025/
For patients on HRT, please see Unscheduled Bleeding on HRT
Thrombocytosis is a risk marker for malignancy. This especially applies to the ‘LEGO-C’ group – Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer. See Thrombocytosis – RefHelp for more information.
MM & RC 22/1/26
Who to refer:
Patients with Post-Menopausal Vaginal Bleeding and:
- Clinical examination suggests vulval/vaginal/cervical malignancy
- Currently using Tamoxifen or have used it in the past
- Lynch or Cowden Syndrome
- BRCA1 or BRCA2 carriers without bilateral salpingo-oophrectomy
- Pelvic USS with endometrial thickness (≥5.0mm): we now ask all clinicians to send an onward referral to Gynaecology (RIE>Gynaecology>PMB abnormal scan result)
- Pelvic USS where a copper IUCD present or Progesterone IUCD present for >5 years
- Pelvic USS with ovarian pathology (see ovarian cyst and ovarian cancer pathway)
- Second or subsequent episode(s) of PMB, more than 6 months since reassuring prior assessment (even if endometrium <5.0mm on prior Pelvic USS)B.
For patients on HRT, please see Unscheduled Bleeding on HRT.
There are 2 situations, as below, where patients who are, or have recently been, on HRT should be referred for a PMB USS (not an Unscheduled Bleeding on HRT USS):
- Ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions (Unscheduled Bleeding on HRT)
- Ongoing bleeding at 6 weeks since stopping HRT (Unscheduled Bleeding on HRT)
Who not to refer:
- Women with PMB, normal clinical examination and endometrial thickness less than 5.0mm, in the absence of focal pathology e.g. polyp.
How to refer:
1. For patients with PMB
Refer to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
If the USS report is reported as abnormal (ET ≥5mm) Primary Care Clinician to refer patient to Gynaecology
Sci-Gateway > RIE > Gynaecology > LI PMB Abnormal Ultrasound
Where the USS is reported as abnormal (ET ≥5mm) the report will be emailed by radiology to the Clinical Inbox of the referring GP practice and will require the Primary Care Clinician to inform the patient and to send a USOC SCI Gateway referral. It will also be emailed to the Gynaecology cancer clinic.
2. For patients with PMB on tamoxifen
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
3.For suspected vulval, vaginal, cervical malignancy:
USOC Referral Gynaecology Sci-Gateway > RIE> Gynaecology> LI Basic sign referral (select priority USOC)
4.For recurrent/persistent PMB:
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
5.For patients with ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions Unscheduled Bleeding on HRT:
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
6.For patients with ongoing bleeding at 6 weeks since stopping HRT Unscheduled Bleeding on HRT link:
USOC Referral Gynaecology Sci-gateway > RIE > Gynaecology > LI Basic sign referral (select priority USOC) and simultaneous referral to Radiology for PMB USS Sci-Gateway > ELCH/LB/RIE/SJH > Clinical Radiology > LI PMB (No HRT)
