Reasoning GP Clinic reference Suspected cancer referrals (NG12)
Clinic reference · NICE NG12 · reference only

Suspected cancer referrals — symptom, age, action

A searchable summary of NICE NG12 by cancer site: which symptoms at which age need a suspected cancer pathway referral, a very urgent referral, a direct access test or a test first. Reference only — use your ICB proforma and check the full recommendation for borderline cases.

Last checked: October 2026 · NICE NG12, last updated 15 April 2026
What changed recently. NG12 was last updated on 15 April 2026: age-specific CA125 thresholds for ovarian cancer from age 40 (and no CA125 alone at 39 and under), amended endometrial recommendations, and the non-site-specific weight loss recommendation (1.13.2). In May 2025 oesophageal and stomach cancer moved to suspected cancer pathway referral (instead of direct access endoscopy); in April 2025 myeloma testing changed to serum free light chains instead of urine Bence Jones protein.
Reference only. Use your ICB's suspected cancer referral proforma — local forms decide the route (for example straight-to-test endoscopy, FIT thresholds, non-specific symptoms services) and the information you must include. "Suspected cancer pathway" is NICE's term for the old "2-week wait"; the 28-day Faster Diagnosis Standard applies from referral. Children and young people have lower thresholds — paediatric cancer referral.
Key: Suspected cancer pathwayVery urgent 48 hDirect access testUrgent / test firstConsider
Symptom or findingAgeActionGo to

Using the table well

  • "Consider" means NICE leaves it to clinical judgement; "refer" / "offer" rows are firmer recommendations. Rows are summarised in our words — check the numbered recommendation before acting on a borderline case.
  • Safety-net every time: explain why you are referring, what will happen, and to come back if symptoms change. Record that cancer was discussed.
  • A normal test does not end the story — negative FIT, CA125 or chest X-ray with persisting symptoms still needs review, specialist advice or the non-specific symptoms pathway.
  • Related pages: weight loss · haematuria · rectal bleeding · abnormal cancer markers · screening programmes · QOF cancer care review.

Sources (checked October 2026)

  1. NICE. NG12 Suspected cancer: recognition and referral (2015; last updated 15 April 2026) — recommendations and update information. nice.org.uk/guidance/ng12
  2. NICE. NG12 update information: April 2026 (ovarian CA125 and age thresholds 1.5.6–1.5.9 and 1.5.11; endometrial 1.5.12, 1.5.14, 1.5.15; non-site-specific weight loss 1.13.2), May 2025 (oesophageal and stomach), April 2025 (myeloma tests). nice.org.uk
  3. NICE. Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care (DG56, 2023; now HTG690). nice.org.uk
  4. GatewayC. New NICE guidance for CA125: why age matters (2026). gatewayc.org.uk
Educational reference only — not a substitute for the source guidance or clinical judgement. Summarised in our own words from the national sources listed, last checked October 2026. Rules, eligibility and thresholds change, and local commissioning (ICB) arrangements vary: always check the live guidance, the product SPC, the BNF/BNFC and your local formulary or protocol before acting. No patient-specific dosing is given here.