{"id":20531,"date":"2024-08-21T10:10:02","date_gmt":"2024-08-21T09:10:02","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=20531"},"modified":"2026-02-12T08:40:47","modified_gmt":"2026-02-12T08:40:47","slug":"urgent-suspected-upper-gi-cancer","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/urgent-suspected-upper-gi-cancer\/","title":{"rendered":"Urgent Suspected Upper GI Cancer"},"content":{"rendered":"\n<p>Urgent Referrals for suspected <strong>Oesophago-gastric Upper GI Cancer<\/strong> are based on the <a href=\"https:\/\/www.cancerreferral.scot.nhs.uk\/oesophago-gastric-hepatobiliary-and-pancreatic-cancers\/?alttemplate=Guideline\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer<\/a><\/p>\n\n\n\n<p>Upper GI USOC Referrals are divided into two referral pathways:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Referrals where <strong>Dysphagia <\/strong>is the main presenting symptom. For referrals for this group of patients please see the detailed guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/dysphagia\/\">Dysphagia RefHelp page<\/a>.<\/li>\n\n\n\n<li>Referrals for patients with <strong>unexplained weight loss* <\/strong>(particularly &gt;55 years)<strong> <\/strong>with<strong> any <\/strong>of the additional symptoms of <strong>upper abdominal pain, early satiety, reflux, dyspepsia, nausea and\/or vomiting<\/strong>. This page covers this second group of patients.<\/li>\n<\/ul>\n\n\n\n<p>*The <a href=\"https:\/\/rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/upper-gastrointestinal-cancers\/?alttemplate=Guideline\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a> specifically note that weight loss is \u201c5% or more of body weight <strong>or strong clinical suspicion<\/strong>.\u201d<\/p>\n\n\n\n<p>Related guidance for patients where there is an <strong>Urgent Suspicion of Cancer<\/strong> can also be found on the following pages:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/irondeficiencyanaemia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Iron Deficiency Anaemia<\/a> GI page<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer with no clinically obvious primary<\/a> page<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thrombocytosis<\/a>\u00a0page &#8211; see specific section on THROMBOCYTOSIS &amp; CANCER \u2013 the \u2018LEGO-C\u2019 group\u00a0(Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer)<\/li>\n<\/ul>\n\n\n\n<p>Uncomplicated Dyspepsia (i.e. in the absence of weight loss or other alarm symptoms as noted above, is rarely, if ever, a presenting feature of upper GI Cancer, and not an indication for USOC referral. For advice on how to refer these patients, please see guidance on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/dyspepsia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dyspepsia<\/a> page.<\/p>\n\n\n\n<p><strong><em>Updated Oct 25 IA, CN, LP &amp; JB<\/em><\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexplained <strong>weight loss**<\/strong>, particularly &gt;55 years, combined any of the following features:\n<ul class=\"wp-block-list\">\n<li>Upper abdominal pain (particularly if new or worsening)<\/li>\n\n\n\n<li>Early satiety<\/li>\n\n\n\n<li>Reflux symptoms<\/li>\n\n\n\n<li>Dyspepsia<\/li>\n\n\n\n<li>Nausea and\/or vomiting<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>** <strong>Weight loss: <\/strong>Please provide clear documentation of weight loss, when possible, noting actual weights along with total kg lost and\/or total % of body weight loss. Specific measurements aid triage.<\/p>\n\n\n\n<p>The <a href=\"https:\/\/rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/upper-gastrointestinal-cancers\/?alttemplate=Guideline\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer 2025<\/a> specifically note that weight loss is \u201c5% or more of body weight <strong>or strong clinical suspicion<\/strong>.\u201d<\/p>\n\n\n\n<p><strong>Please remember that all<\/strong>&nbsp;patients with dysphagia&nbsp;should be urgently (USoC) referred to upper GI for upper GI endoscopy using the specific <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/dysphagia\/\" target=\"_blank\" rel=\"noreferrer noopener\">Dysphagia referral pathway<\/a>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><strong><\/strong><\/h4>\n\n\n\n<p>Referral is via SGI Gateway to RIE,  SJH and WGH using the <strong>GI Upper excl Dysphagia<\/strong> referral pathway:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RIE &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; LI GI Upper excl Dysphagia (priority USOC)<\/li>\n\n\n\n<li>SJH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; LI GI Upper excl Dysphagia (priority USOC)<\/li>\n\n\n\n<li>WGH &gt;&gt; Gastroenterology \u2013 Medical &gt;&gt; LI GI Upper excl Dysphagia (priority USOC)<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-8d5d2a8b6eaebf2364b030863a1199e8\"><strong>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.<\/strong><\/p>\n\n\n\n<p><strong>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.<\/strong><strong><\/strong><\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-52034e571215933630d8b3fa764dbe92\"><strong>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.<\/strong><\/p>\n\n\n\n<p><strong>What Information should be included:<\/strong><strong><\/strong><\/p>\n\n\n\n<p><strong>Protocol Text Tab<\/strong><strong><\/strong><\/p>\n\n\n\n<p>The protocol text tab asks a number of specific questions based on the <strong>Scottish Cancer Referral Guidelines<\/strong>. The answers to these questions help the Gastrointestinal team to triage referrals appropriately. This is very important for USOC referrals especially.<\/p>\n\n\n\n<p><strong><span style=\"text-decoration: underline\">Questions for all patients<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age<\/strong>: &lt; 40 years \/ 40-55 years \/ &gt; 55 years<\/li>\n\n\n\n<li><strong>Duration of symptoms<\/strong>: Unknown \/ &lt; 1 month \/ 1-3 months \/ 3-6 months \/ &gt; 6 months<\/li>\n\n\n\n<li><strong>Unexplained weight loss (<strong>greater than 5% of body weight or strong clinical suspicion)<\/strong> <\/strong>: Yes \/ No<\/li>\n<\/ul>\n\n\n\n<p><strong><span style=\"text-decoration: underline\">Questions for patients with unexplained weight loss<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>New or worsening upper abdominal pain or discomfort<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Reflux<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Dyspepsia resistant to treatment<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Vomiting<\/strong>: Yes \/ No<\/li>\n<\/ul>\n\n\n\n<p><strong><span style=\"text-decoration: underline\">Questions for all patients<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>New persistent vomiting for more than 2 weeks<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Epigastric Mass<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Significant Haematemesis<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Melaena<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Current NSAID use<\/strong>: Yes \/ No<\/li>\n\n\n\n<li><strong>Fe-deficiency anaemia<\/strong>: Yes \/ No<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Previous GI investigations<\/strong>: Details to be written into free text box<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Key Information for endoscopy (e.g. anticoagualation, prosthetic heart valve, diabetic on insulin, severe comorbidity)<\/strong>: Yes \/ No (and a request to provide details under the Referral Text Tab)<\/li>\n<\/ul>\n\n\n\n<p><strong>Information to include in referral under Referral Text Tab <\/strong><strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Further clinical history relevant to referral<\/li>\n\n\n\n<li>Details of any key information required for endoscopy<\/li>\n\n\n\n<li>Any information on comorbidities and frailty, including (if appropriate) a Frailty score<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hoarse voice (consider ENT referral).<\/li>\n\n\n\n<li>Coexisting iron deficiency anaemia.<\/li>\n\n\n\n<li>Coughing \/ choking during or after drinking.<\/li>\n\n\n\n<li>Progressive dysphagia particularly for solids.<\/li>\n\n\n\n<li>Regurgitation.<\/li>\n\n\n\n<li>Details of any GLP-1 prescriptions (medication and timing of use)<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-8d5d2a8b6eaebf2364b030863a1199e8\"><strong>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.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>After Referral<\/strong><strong><\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.<\/li>\n\n\n\n<li>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<\/li>\n\n\n\n<li>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<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.cancerreferral.scot.nhs.uk\/oesophago-gastric-hepatobiliary-and-pancreatic-cancers\/?alttemplate=Guideline\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Cancer Referral Guidelines &#8211; Upper GI Pathways<\/a><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PPV-of-symptoms-for-UGI-Cancer.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PPV-of-symptoms-for-UGI-Cancer.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PPV of symptoms for UGI Cancer<\/a><\/strong><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Urgent Referrals for suspected Oesophago-gastric Upper GI Cancer are based on the Scottish Referral Guidelines for Suspected Cancer Upper GI USOC Referrals are divided into two referral pathways: *The Scottish Referral Guidelines for Suspected Cancer 2025 specifically note that weight loss is &ldquo;5% or more of body weight or strong clinical suspicion.&rdquo; Related guidance for<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3955,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1128],"class_list":["post-20531","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-urgent-suspected-upper-gi-cancer"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gastrointestinal\/https-apps-nhslothian-scot-refhelp-urgent-suspected-upper-gi-cancer\/\" rel=\"tag\">Urgent suspected upper GI cancer<\/a>","rttpg_excerpt":"Urgent Referrals for suspected Oesophago-gastric Upper GI Cancer are based on the Scottish Referral Guidelines for Suspected Cancer Upper GI USOC Referrals are divided into two referral pathways: *The Scottish Referral Guidelines for Suspected Cancer 2025 specifically note that weight loss is &ldquo;5% or more of body weight or strong clinical suspicion.&rdquo; Related guidance for","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20531","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=20531"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20531\/revisions"}],"predecessor-version":[{"id":26794,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20531\/revisions\/26794"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3955"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=20531"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=20531"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}