Synopsis
Recognise symptom patterns that may represent cancer, identify emergencies, use current NICE referral routes and direct-access tests, and safety-net patients whose initial probability remains uncertain.
- Cancer recognition combines symptom, examination, age, duration, risk factors and trajectory; no single red flag is sufficiently sensitive to exclude disease when absent.
- Use the current NICE NG12 site-based or symptom-based recommendations and local referral form rather than memorised historical thresholds.
- An urgent suspected-cancer referral means cancer must be excluded promptly; it does not mean that cancer is the most likely diagnosis.
- Some pathways begin with a primary-care test such as chest radiography, full blood count, FIT, CA125 or ultrasound, but the correct sequence is symptom-specific.
- A normal initial test does not close the case when symptoms persist, progress or remain discordant with the result.
- Explain the reason for referral, expected contact time and how to chase a missing appointment; unclear language increases non-attendance and distress.
- Safety-net every unresolved presentation with a named review interval, trigger symptoms and ownership of outstanding results.
- Consider cancer in people with multimorbidity and in younger adults when the pattern is unusual; diagnostic overshadowing causes delayed diagnosis.
Key red flags
Increasing dysphagia, jaundice, bowel obstruction, stridor or urinary obstruction suggests structural disease and may need acute rather than outpatient care.
New focal weakness, sphincter disturbance, severe bone pain, confusion or hypercalcaemic dehydration may be the first cancer presentation.
Investigation priorities
Localise the likely organ system and identify emergency complications.
Management branches
The presentation includes airway, neurological, haemorrhagic, obstructive or metabolic instability.
- Use ABCDE assessment, treat immediate physiology and contact the relevant acute oncology, surgical, critical-care or site team.
- Obtain urgent targeted imaging and blood tests without allowing the absence of a known cancer diagnosis to delay emergency treatment.
- After stabilisation, coordinate tissue diagnosis and staging so emergency intervention does not fragment the longer cancer pathway.