Scottish referral guidelines for suspected cancer: quick reference guide

Oesophago-Gastric, Hepatobiliary and Pancreatic Cancers

Oesophago-gastric cancer

Urgent suspicion of cancer referral

• Dysphagia (interference of the swallowing mechanism that occurs within five seconds of the swallowing process) or unexplained odynophagia (pain on swallowing) at any age
• 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

Hepatobiliary and pancreatic cancer

Urgent suspicion of cancer referral

• Painless obstructive jaundice
• Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
• upper abdominal or epigastric mass
• new onset diabetes
• any suspicious abnormality, in the hepatobiliary tract, found on imaging (such as biliary dilatation or pancreatic/liver lesion)
• new onset, unexplained back pain (consider other cancer causes including myeloma or malignant spinal cord compression)
• ongoing GI symptoms despite negative endoscopic investigations

Oesophago-gastric cancer

Good practice points

Consider routine referral for people presenting with new upper gastrointestinal pain or discomfort combined with any of the following risk factors:

• family history of oesophago-gastric cancer in a first-degree relative
• Barrett’s oesophagus
• pernicious anaemia
• previous gastric surgery
• achalasia (dysfunction of the oesophageal muscle)
• known dysplasia, atrophic gastritis or intestinal metaplasia

Primary care management

• Dyspepsia without accompanying symptoms or risk factors should be managed according to local or national guidelines

Hepatobiliary and pancreatic cancer

Good Practice Points

• Consider seeking advice in people presenting with new onset GI symptoms with known chronic liver disease

There is emerging evidence that thrombocytosis is a risk marker for underlying cancer, including gastric and oesophageal. Remember “LEGO-C”.