Reviewed on : 11 Aug 2026

Reviewed by : GP Gateway Editor

Expires : 11 Aug 2028

BRAIN URGENT SUSPECTED CANCER REFERRAL

Brain & CNS USC Pathway

As per NICE guidance NG12, adults with progressive, sub-acute loss of central neurological function, suggestive of brain / CNS cancer should be considered for direct access brain imaging to be performed within 2 weeks.

Patients referred on this pathway will be triaged and booked for urgent (within 2 weeks) CT head

An MRI will automatically be arranged should the CT not provide definitive diagnosis

Indications for an urgent referral for a suspected new malignancy

Patients who present with subacute 6 weeks of any of:

• Headache and features suggestive of raised intracranial pressure (e.g. new morning headaches with nausea and vomiting, irritability, worse with postural change, coughing, sneezing)
• New headache and focal neurological deficit on examination
• Change in personality or behaviour (not confusion/suspecting dementia)
• Upper motor neurone signs with unilateral limb weakness
• Expressive/ receptive or mixed dysphasia
• Subacute progressive diplopia or hemianopia

Exclusions:

• Patients currently under oncological surveillance (routine or patient initiated) Urgent referral to oncology (oncology@uhcw.nhs.uk)
• Patients suspected of having dementia Routine referral for CT head/referral to memory clinic
• Patients with non acute change in chronic headache Neurology advice and guidance

Patients with red flag symptoms should be referred to ED:

• • Thunderclap headache
  • Suspected meningitis
  • Pregnant (postpartum) with new headache, seizures, focal neurological signs, visual or cognitive impairment
  • Signs suggestive of Stroke
  • New papilloedema or acute visual change (refer Eye Casualty) 

Outcomes:

Once imaging is completed patients will have one of four outcomes:

(See attached flow chart for further detail)

• Normal imaging – result to GP and patient discharged from pathway
• Non cancer pathology – result to GP with clinical advice
• Primary brain cancer – neuro oncology CNS notifies patient, brain CNS pathway followed
• Brain metastasis – NSS team notify patient and arrange further investigations

Brain CNS Radiology FAQ

The Brain Radiology FAQ (link) has been produced by the neurosurgical, neurology and neuroradiology departments to provide helpful information for incidental findings

This does not replace guidance that will be given in radiology reports and is distinct from the Brain/CNS USC pathway