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Weight loss in adults - NICE urgent cancer referral guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Weight loss

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained)

Several, including colorectal, gastro-oesophageal, lung, prostate, pancreatic or urological cancer

Carry out an assessment for additional symptoms, signs or findings that may help to clarify which cancer is most likely

Offer urgent investigation or a suspected cancer pathway referral (for an appointment within 2 weeks)

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained) aged 60 or over with any of the following:

  • diarrhoea
  • back pain
  • abdominal pain
  • nausea
  • vomiting
  • constipation new-onset diabetes

Pancreatic

consider urgent direct access CT scan

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained) with abdominal pain, 40 and over

Colorectal

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks)

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained) with rectal bleeding in adults under 50

Colorectal

Consider a suspected cancer pathway referral (for an appointment within 2 weeks)

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained) without rectal bleeding, 50 and over

Colorectal

Offer testing for occult blood in faeces

See primary care investigations for more information on tests for occult blood in faeces (faecal immunochemical testing)

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained), 40 and over, ever smoked

Lung or mesothelioma

Offer a chest X-ray

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained), 40 and over, exposed to asbestos

Mesothelioma

Offer a chest Xray

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with cough or fatigue or shortness of breath or chest pain or appetite loss (unexplained), 40 and over, never smoked

Lung or mesothelioma

Offer a chest Xray

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with unexplained splenomegaly in adults

Non-Hodgkin's lymphoma

Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with unexplained lymphadenopathy in adults

Hodgkin's lymphoma or non-Hodgkin's lymphoma

Consider a suspected cancer pathway referral (for an appointment within 2 weeks). When considering referral, take into account any associated symptoms

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with upper abdominal pain or reflux or dyspepsia, 55 and over

Oesophageal or stomach

Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks)

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss (unexplained) in women

Ovarian

Measure serum CA125 in primary care

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with diarrhoea or back pain or abdominal pain or nausea or vomiting or constipation or new-onset diabetes, 60 and over

Pancreatic

Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available

 

Symptom and Specific Features

Possible Cancer

Recommendation

Weight loss with raised platelet count or nausea or vomiting, 55 and over

Oesophageal or stomach

Consider non-urgent direct access upper gastrointestinal endoscopy

Reference:


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