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Cancer

Gynaecological cancers - recognition and referral

Last revised in May 2026

Ovarian cancer - Over 7,000 new ovarian cancers are diagnosed each year in the UK.

Gynaecological cancers - recognition and referral: Summary

  • Ovarian cancer — over 7000 new ovarian cancers are diagnosed each year in the UK. A full-time GP is likely to diagnose approximately one person with ovarian cancer every 3–5 years. Around 45% of women survive for 5 years or more after diagnosis. 
  • Make a referral to a gynaecological cancer service using a suspected cancer pathway referral if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).
  • Ovarian cancer should be suspected and tests carried out in any woman, or a trans man or non-binary person with female reproductive organs (particularly if over 50 years of age) if any of the following symptoms are persistent or frequent (particularly more than 12 times per month):
    • Abdominal distension (bloating).
    • Feeling full (early satiety) and/or loss of appetite.
    • Pelvic or abdominal pain.
    • Increased urinary urgency and/or frequency. 
  • Ovarian cancer should also be suspected and tests carried out in any woman, or a trans man or non-binary person with female reproductive organs over 50 years of age if she has had symptoms suggestive of irritable bowel syndrome within the last 12 months.
  • The possibility of ovarian cancer (and investigations arranged) should be considered in a woman who reports any of the following unexplained symptoms:
    • Weight loss.
    • Malaise or fatigue.
    • Change in bowel habit.
  • Other symptoms of ovarian cancer that may be present include:
    • Abnormal or postmenopausal bleeding.
    • Gastrointestinal symptoms, such as dyspepsia, nausea, and bowel obstruction.
    • Shortness of breath (due to pleural effusion).
  • For women, and trans men and non-binary people with female reproductive organs who are aged 39 or under with persistent symptoms that suggest ovarian cancer:
    • Do not use serum CA125 measurement in isolation for decision making.
    • Consider an urgent, direct access ultrasound scan of the abdomen and pelvis. 
  • For women, and trans men and non-binary people with female reproductive organs who are aged 40 or over with persistent symptoms that suggest ovarian cancer, measure CA125 in primary care.
  • Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125  measurement. 
  • If an ultrasound scan suggests ovarian cancer, make a referral to a gynaecological cancer service using a suspected cancer pathway referral.
  • If the serum CA125 does not meet the threshold outlined in the recommendations, or meets the threshold but the ultrasound scan is normal:
    • Identify any other potential causes of the symptoms and investigate as appropriate.
    • If no other cause is identified, advise a return to the GP if the symptoms become more frequent or persistent, or both.
  • If the ultrasound suggests ovarian cancer, refer the woman urgently for further investigation.
  • Endometrial cancer — around 8000 new endometrial cancers are diagnosed each year in the UK. Around 75% of women survive for 5 years or more after diagnosis.
  • Refer women using a suspected cancer pathway referral for endometrial cancer if they are aged 55 years and over with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause). 
  • Consider a suspected cancer pathway referral for endometrial cancer in women aged under 55 years with post-menopausal bleeding.
  • Consider a direct access ultrasound scan to assess for endometrial cancer in women aged 55 years and over with:
    • Unexplained symptoms of vaginal discharge who are presenting with these symptoms for the first time, or have thrombocytosis, or report haematuria, or visible haematuria and low haemoglobin levels, or thrombocytosis, or high blood glucose levels.
  • Cervical cancer — just below 3000 new cervical cancers are diagnosed each year in the UK, around three-quarters of these following screening. Around 60% of women survive for 5 years or more after diagnosis. 
    • Consider a suspected cancer pathway referral for women if, on examination, the appearance of their cervix is consistent with cervical cancer.
  • Vulval cancer — over 1000 new vulval cancers are diagnosed each year in the UK. Around 65% of women survive for 5 years or more after diagnosis.
    • Consider a suspected cancer pathway referral for vulval cancer in women with an unexplained vulval lump, ulceration, or bleeding.
  • Vaginal cancer — over 250 new vaginal cancers are diagnosed each year in the UK. Around 25% of women survive for 5 years or more after diagnosis. 
    • Consider a suspected cancer pathway referral for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina.

Have I got the right topic?

From birth onwards (Female).

This CKS topic is based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2026].

This topic covers the recognition and referral of suspected cancer.

This CKS topic does not cover the management of patients with suspected gynaecological cancer.

There are separate CKS topics on Cervical cancer and HPV, Cervical screening, Endometriosis, Menorrhagia, and Ovarian cancer.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

May 2026 — Minor update. Update related to changes in NICE ovarian cancer guidance. 

Previous changes

August 2025 — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral. Minor structural changes have been made to this topic.

April 2025 — minor update. QOF indicators removed in line with NHS England's 2025 Quality and Outcomes Framework.

February 2021 — minor update. Minor changes to align with house style. 

August 2020 — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence guideline Suspected cancer: recognition and referral.

November 2016 — minor update. The National Institute for Health and Care Excellence (NICE) quality standards for suspected cancer have been added to this topic.

September to October 2015 — reviewed. This topic is a direct implementation of the National Institute for Health and Care Excellence guideline Suspected cancer: recognition and referral (2015). This CKS topic replaces the former topic on Gynaecological cancer - suspected.

August 2013 — recommendations on when to suspect ovarian cancer have been updated in line with new guidance from the National Institute for Health and Clinical Excellence (NICE) on Ovarian cancer: the recognition and initial management of ovarian cancer.

July 2009 — converted from CKS guidance to Primary topic structure. No changes to recommendations have been made. 

September 2008 — minor correction to the Changes section. 

November 2005 — minor technical update. 

July 2005 — revised to reflect the update to the Referral guidelines for suspected cancer published by the National Institute for Health and Care Excellence.

April 2000 — issued in December 2000.

Update

New evidence

Evidence-based guidelines

National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2026].

HTAs (Health Technology Assessments)

No new HTAs since 1 August 2025.

Economic appraisals

No new economic appraisals relevant to England since 1 August 2025.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 August 2025.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 August 2025.

New policies

No new national policies or guidelines since 1 August 2025.

New safety alerts

No new safety alerts since 1 August 2025.

Changes in product availability

No changes in product availability since 1 August 2025.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Recognize symptoms suggestive of gynaecological cancers.
  • Refer people with suspected gynaecological cancers within clinically appropriate timescales.
  • Offer appropriate patient information and support for people with suspected cancer.

Outcome measures

No outcome measures were identified for this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

Suspected Cancer

  • GPs have direct access to diagnostic endoscopy, ultrasound, MRI, X-ray and CT for people with suspected cancer.
  • People presenting in primary care with symptoms that suggest oesophageal or stomach cancer have an urgent direct access upper gastrointestinal endoscopy.
  • Adults presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces.
  • People with suspected cancer who are referred to a cancer service are given written information encouraging them to attend.

[NICE, 2021]

Background information

Presentation

  • Ovarian cancer
    • Ovarian cancer can present with a number of different symptoms, and there are often multiple symptoms simultaneously.
    • Symptoms include abdominal pain, abnormal vaginal bleeding, loss of weight, loss of appetite, and fatigue. The cancer may also present with abdominal distension.
    • Most ovarian cancers lead to a raised serum CA125, a blood test that can be performed in primary care.
    • Ultrasound, particularly transvaginal, can image the ovaries well, and is generally used after a raised CA125 is found, or where there is continuing suspicion despite a normal CA125. Access to ultrasound is generally available in primary care.
    • Definitive diagnosis requires biopsy, performed in secondary care.
  • Endometrial cancer
    • The most common symptom of endometrial cancer is abnormal vaginal bleeding, particularly after the menopause.
    • This feature of endometrial cancer can also be present in other cancers, especially cervical or ovarian cancer.
    • The main method of diagnosis is by endometrial biopsy, which is performed in secondary care.
  • Cervical cancer
    • The reported symptoms of cervical cancer include intermenstrual and post-coital bleeding, vaginal discharge, and pain.
    • A diagnosis of cervical cancer is generally made by biopsy, performed in secondary care.
  • Vulval cancer
    • Vulval cancer is believed to usually present with a mass or ulceration, with vulval itch or redness.
    • Definitive diagnosis requires biopsy, performed in secondary care.
  • Vaginal cancer
    • Vaginal cancer is believed to usually present with a mass or ulceration within the vagina.
    • Definitive diagnosis requires biopsy, performed in secondary care.

[NICE, 2026]

How common is it?

  • Ovarian cancer:
    • Over 7000 new ovarian cancers are diagnosed each year in the UK.
    • A full-time GP is likely to diagnose approximately one person with ovarian cancer every 3–5 years.
  • Endometrial cancer:
    • Around 8000 new endometrial cancers are diagnosed each year in the UK.
    • A full-time GP is likely to diagnose approximately one person with endometrial cancer every 3–5 years.
  • Cervical cancer:
    • Just below 3000 new cervical cancers are diagnosed each year in the UK, around three-quarters of these following screening.
    • A full-time GP is likely to diagnose one person with cervical cancer approximately every 10 years.
  • Vulval cancer:
    • Over 1000 new vulval cancers are diagnosed each year in the UK.
    • A full-time GP is likely to diagnose approximately one person with vulval cancer during their career.
  • Vaginal cancer:
    • Over 250 new vaginal cancers are diagnosed each year in the UK, meaning most GPs will not encounter a woman with the disease during their career.

[NICE, 2026]

What is the prognosis?

  • Ovarian cancer
    • Around 45% of women will survive for 5 years or more after diagnosis. [CRUK, 2024a]. 
  • Endometrial cancer
    • Around 75% of women will survive for 5 years or more after diagnosis [CRUK, 2024b].
  • Cervical cancer
    • Around 60% of women will survive for 5 years or more after diagnosis [CRUK, 2023].
  • Vulval cancer
    • Around 65% of women will survive for 5 years or more after diagnosis [CRUK, 2022]. 
  • Vaginal cancer
    • Around 25% of women will survive for 5 years or more after diagnosis [CRUK, 2024c].

Diagnosis of gynaecological cancers

What symptoms are suggestive of gynaecological cancers?

Table 1. Symptoms suggestive of gynaecological cancers.

Symptom and specific featuresPossible cancerRecommendation
Appearance of cervix consistent with cervical cancerCervicalConsider a suspected cancer pathway referral 
Blood glucose levels high with visible haematuria in women aged 55 years and overEndometrial Consider a direct access ultrasound scan
Haemoglobin levels low with visible haematuria in women aged 55 years and overEndometrial Consider a direct access ultrasound scan
Haematuria (visible) with low haemoglobin levels or thrombocytosis or high blood glucose levels or unexplained vaginal discharge in women aged 55 years and overEndometrial Consider a direct access ultrasound scan
Post-menopausal bleeding in women aged 55 years and over (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause)EndometrialRefer using a suspected cancer pathway referral 
Post-menopausal bleeding in women aged under 55 years (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause)EndometrialConsider a suspected cancer pathway referral 
Thrombocytosis with visible haematuria or vaginal discharge (unexplained) in women aged 55 years and overEndometrial Consider a direct access ultrasound scan
Vaginal discharge (unexplained) either at first presentation or with thrombocytosis or with haematuria, in women aged 55 years and overEndometrial Consider a direct access ultrasound scan
Appetite loss or early satiety (persistent or frequent – particularly more than 12 times per month) in women, especially if aged 50 years and overOvarian 

Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Abdominal distension (persistent or frequent – particularly more than 12 times per month) in women, especially if aged 50 years and overOvarian 

Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Ascites and/or a pelvic or abdominal mass identified by physical examination (which is not obviously uterine fibroids) in womenOvarian Refer using a suspected cancer pathway referral
Abdominal or pelvic mass identified by physical examination (which is not obviously uterine fibroids) in womenOvarianRefer using a suspected cancer pathway referral
Abdominal or pelvic pain (persistent or frequent – particularly more than 12 times per month) in women, especially if aged 50 years and overOvarian 

Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Irritable bowel syndrome symptoms within the last 12 months in women aged 50 years and overOvarian 

Carry out appropriate tests for ovarian cancer, because irritable bowel syndrome rarely presents for the first time in women of this age*

Measure serum CA125*

Change in bowel habit (unexplained) in womenOvarian 

Consider arranging an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Fatigue (unexplained) in womenOvarian 

Consider arranging an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Urinary urgency or frequency (increased and persistent or frequent – particularly more than 12 times per month) in women, especially if aged 50 years and overOvarian 

Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Weight loss (unexplained) in womenOvarian 

Consider arranging an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125*

Vaginal mass (unexplained and palpable) in or at the entrance to the vaginaVaginal Consider a suspected cancer pathway referral
Vulval bleeding (unexplained) Vulval Consider a suspected cancer pathway referral 
Vulval lump or ulceration (unexplained)Vulval Consider a suspected cancer pathway referral
* The recommendations for ovarian cancer apply to women aged 18 years and over
Data from: [NICE, 2025]

Basis for recommendation

This information is based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2026]

How should I manage investigation results?

Table 2. Managing investigation results.

Investigation resultPossible cancerRecommendation
Serum CA125 resultsOvarian 

If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis*

Normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound: assess carefully for other clinical causes of her symptoms and investigate if appropriate. If no other clinical cause is apparent, advise her to return if symptoms become more frequent and/or persistent*

Ultrasound suggests ovarian cancerOvarian 

Refer using a suspected cancer pathway referral

Ultrasound normal with CA125 of 35 IU/ml or greaterOvarian 

Assess carefully for other clinical causes if symptoms and investigate if appropriate*

If no other clinical cause is apparent, advise to return if symptoms become more frequent and/or persistent*

* These recommendations for ovarian cancer apply to women aged 18 years and over
Data from: [NICE, 2025]

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

Management

Scenario: Referral for suspected gynaecological cancer

From birth onwards (Female).

How should I refer a person with suspected ovarian cancer?

  • Make a referral to a gynaecological cancer service using a suspected cancer pathway referral if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).

  • For women, trans men and non-binary people with female reproductive organs who are aged 39 years or under with persistent symptoms that suggest ovarian cancer:

    • Do not use serum CA125 measurement in isolation for decision making (it is not an accurate indicator of ovarian cancer risk in this age group; although the risk of ovarian cancer is low, it remains a clinical concern and is often diagnosed late).
    • Consider an urgent, direct access ultrasound scan of the abdomen and pelvis. 
  • If the ultrasound scan outlined above is normal:
    • Identify any other potential causes of the symptoms and investigate as appropriate, and
    • If no other cause is identified, advise a return to the GP if the symptoms become more frequent or persistent, or both. 
  • For women, trans men and non-binary people with female reproductive organs who are aged 40 or over with persistent symptoms that suggest ovarian cancer, measure CA125 in primary care.
  • Arrange an urgent, direct access ultrasound scan of the abdomen and pelvis depending on age and serum CA125 according to the thresholds below.

Table 1 Age and serum CA125 thresholds

Age group (years)CA125 threshold
40–49 35 IU/mL or greater
50–59 31 IU/mL or greater 
60–69 24 IU/mL or greater 
70–79 25 IU/mL or greater 
80+ 31 IU/mL or greater 
  • If an ultrasound scan suggests ovarian cancer, make a referral to a gynaecological cancer service using a suspected cancer pathway referral.
  • If the serum CA125 does not meet the threshold outlined in the recommendations above, or meets the threshold but the ultrasound scan is normal:
    • Identify any other potential causes of the symptoms and investigate as appropriate.
    • If no other cause is identified, advise a return to the GP if the symptoms become more frequent or persistent, or both. 

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2026].

When should I refer a person with suspected endometrial cancer?

  • Refer women using a suspected cancer pathway referral for endometrial cancer if they are aged 55 years and over with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause).
  • Consider a suspected cancer pathway referral for endometrial cancer in women aged under 55 years with post-menopausal bleeding.
  • Consider a direct access ultrasound scan to assess for endometrial cancer in women aged 55 years and over with:
    • Unexplained symptoms of vaginal discharge who:
      • Are presenting with these symptoms for the first time, or
      • Have thrombocytosis, or
      • Report haematuria, or
    • Visible haematuria, and:
      • Low haemoglobin levels, or
      • Thrombocytosis, or
      • High blood glucose levels.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

When should I refer a person with suspected cervical cancer?

  • Consider a suspected cancer pathway referral for women if, on examination, the appearance of their cervix is consistent with cervical cancer.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

When should I refer a person with suspected vulval cancer?

  • Consider a suspected cancer pathway referral for vulval cancer in women with an unexplained vulval lump, ulceration, or bleeding.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

When should I refer a person with suspected vaginal cancer?

  • Consider a suspected cancer pathway referral for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

Referral timelines

  • The terms used in the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral are as follows:
    • Immediate: an acute admission or referral occurring within a few hours, or even more quickly if necessary.
    • Very urgent: to happen within 48 hours.
    • Urgent: to happen/be performed within 2 weeks.
    • Non-urgent: the timescale generally used for a referral or investigation that is not considered very urgent or urgent.
    • Suspected cancer pathway referral: the person is to receive a diagnosis or ruling out of cancer within 28 days of being referred urgently by their GP for suspected cancer. 

Basis for recommendation

This information is based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

Diagnostic and referral process

  • Discussion with a specialist (for example, by telephone or email) should be considered if there is uncertainty about the interpretation of symptoms and signs, and whether a referral is needed. This may also enable the primary healthcare professional to communicate their concerns and a sense of urgency to secondary healthcare professionals when symptoms are not classical.
  • Put in place local arrangements to ensure that letters about non-urgent referrals are assessed by the specialist, so that the person can be seen more urgently if necessary.
  • Put in place local arrangements to ensure that there is a maximum waiting period for non-urgent referrals, in accordance with national targets and local arrangements.
  • Ensure local arrangements are in place to identify people who miss their appointments so that they can be followed up.
  • Include all appropriate information in referral correspondence, including whether the referral is urgent or non-urgent.
  • Use local referral proformas if these are in use.
  • Once the decision to refer has been made, make sure that the referral is made within 1 working day.
  • Take part in continuing education, peer review, and other activities to improve and maintain clinical consulting, reasoning, and diagnostic skills, in order to identify at an early stage people who may have cancer, and to communicate the possibility of cancer to the person.

Basis for recommendation

This information is based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

What patient information and support should I offer?

  • Discuss with people with suspected cancer (and their carers as appropriate, taking account of the need for confidentiality) their preferences for being involved in decision-making about referral options and further investigations, including their potential risks and benefits.
  • Explain to people who are being referred with suspected cancer that they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss alternative diagnoses with them.
  • Give the person information on the possible diagnosis (both benign and malignant) in accordance with their wishes for information.
  • The information given to people with suspected cancer and their families and/or carers should cover, among other issues:
    • Where the person is being referred to.
    • How long they will have to wait for the appointment.
    • How to obtain further information about the type of cancer suspected or help before the specialist appointment.
    • What to expect from the service the person will be attending.
    • What type of tests may be carried out, and what will happen during diagnostic procedures.
    • How long it will take to get a diagnosis or test results.
    • Whether they can take someone with them to the appointment.
    • Who to contact if they do not receive confirmation of an appointment.
    • Other sources of support.
  • Provide information that is appropriate for the person in terms of language, ability, and culture, recognizing the potential for different cultural meanings associated with the possibility of cancer.
  • Have information available in a variety of formats on both local and national sources of information and support for people who are being referred with suspected cancer.
  • When referring a person with suspected cancer to a specialist service, assess their need for continuing support while waiting for their referral appointment. This should include inviting the person to contact their healthcare professional again if they have more concerns or questions before they see a specialist.
  • If the person has additional support needs because of their personal circumstances, inform the specialist (with the person's agreement).
  • When cancer is suspected in a child, discuss the referral decision and information to be given to the child with the parents or carers (and the child if appropriate).

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

Safety netting

  • Safety netting involves: 
    • Timely review and action after investigations.
    • Active monitoring of symptoms in people at low risk (but not no risk) of having cancer to see if their risk of cancer changes.
  • Explain to people who are being offered safety netting which symptoms to look out for and when they should return for re-evaluation. It may be appropriate to provide written information. 
  • Reassure people in the safety netting group who are concerned that they may have cancer that with their current symptoms their risk of having cancer is low. 
  • Ensure that the results of investigations are reviewed and acted upon appropriately, with the healthcare professional who ordered the investigation taking or explicitly passing on responsibility for this. Be aware of the possibility of false-negative results for chest X-rays and tests for occult blood in faeces. 
  • Consider a review for people with any symptom that is associated with an increased risk of cancer, but who do not meet the criteria for referral or other investigative action. The review may be: 
    • Planned within a time frame agreed with the person, or
    • Patient-initiated if new symptoms develop, the person continues to be concerned, or their symptoms recur, persist, or worsen.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

Supporting evidence

This CKS topic is based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [NICE, 2025].

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A full literature search was not conducted as this CKS topic is primarily based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral.

Search dates

August 2020 - August 2025

Key search terms

A full literature search was not conducted as this CKS topic is primarily based on the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral.

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

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