Upper GI cancer - Information for referrers
Referral route
Urgent suspected cancer (“2ww”) upper gastroenterology (GI) referrals are managed on e-RS by a ‘Referral Assessment Service (RAS)’. This means appointment bookings cannot be made by the referrer and will ‘defer to provider’. Please refer into ‘2ww RAS Upper GI (including liver)’. We will then triage your referral and book the patient into one of the following services:
- 2ww STT Oesophagogastric (OG)
- 2ww STT Hepatobiliary and pancreatic (HPB)
First appointment will take place by phone unless a face-to-face appointment is required.
Please note that the new straight to test (STT) OG pathway is set up to exclude oesophageal and gastric cancer as well as duodenal cancer. If the patient has pharyngeal dysphagia, please consider an Ear Nose and Throat (ENT) referral and nasal endoscopy as gastroscopy is not the first line investigation in this case.
Please note that the new straight to test HPB pathway is to identify patients with pancreatic, liver and gallbladder cancers. This is not for benign liver, gallbladder or pancreatic diseases
Possible procedures on typical USC (“2ww”) pathway
- OG Pathway - oesophagogastroscopy, CT (subject to the condition)
- HPB Pathway - subject to MDT, may include ERCP, EUS and imaging including ultrasound, MRCP and MRI
Optional tests (concurrent to referral) or other useful information
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Weight loss with no specific GI symptoms - consider cross sectional imaging prior to the referral. CT CAP. See https://gps.cityandhackneyccg.nhs.uk/pathways/direct-access-for-unintentional-significant-weight-loss.
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Abdominal pain - consider ultrasound or CT scan as indicated.
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Anaemia - consider either the UGI or LGI (colorectal) pathway. If cancer is not suspected, request direct access gastroscopy and Referral Assessment Service (RAS) colonoscopy on e-RS if patient fits service criteria. Please ensure patients have urinary dipstick to exclude microscopic haematuria and, for women, menorrhagia as a cause of iron deficiency anaemia.
Vitamin b12 and folate
Things the hospital or patient need to know
Confirm patient's phone number as first appointment may be by phone.
What the hospital tells the patient in letters
Phone appointment
We will try our best to call you on time. Please allow one hour from your appointment time for this call. Keep your phone free and nearby you during this time. Do make sure your phone can receive calls from private or withheld numbers. (You can check this with your telephone provider). Try to stay in a quiet place during the call.
Your telephone appointment may be with a nurse or a doctor. You may need to have tests before your appointment. If so, someone will be in touch with the details. Please ensure you attend these tests before your appointment if we call you about these.
Outpatient appointment
We try hard to minimise delays in clinic, but you should allow up to 2 hours for your appointment. You may be required to have some tests when you attend the clinic.
You may be asked to have tests before your appointment. If so, someone will get in touch with the details. Please make sure you have these tests before your appointment if we ask you to do these.
Useful information