Reviewed on : 22 Oct 2026

Reviewed by : Jack Bambrough - GP Gateway Editor

Expires : 22 Oct 2028

Introduction

This page is for patients with suspicion of oesophageal/gastric cancer. There is now a separate referral form for hepatic/pancreatic/biliary cancer which can be found here.

Inclusion criteria

This pathway is for adults over 16 years old with:

• New onset dysphagia -food sticking on swallowing (please complete cancer dysphagia score, more detail below)
  • A Cancer Dysphagia Score of ≥ 5.5 should proceed to urgent straight to test (STT) endoscopy if fit.
  • A Cancer Dysphagia Score of < 5.5 must be referred via GASTRO REFERRAL.
• Dyspepsia
  • Age >55 AND weight loss (>5%) AND any of NEW:
    • Abdominal pain
    • Dyspepsia
    • Reflux
• Upper abdominal mass (for suspected HPB mass use USC upper GI HPB referral form)
• Imaging report suggestive of gastric or oesophageal malignancy

Cancer dysphagia score

This scoring allows better risk-stratification of dysphagia. Validation studies published by the Royal College of Surgeons in 2026 show CDS has a negative predictive value of 99.74% for cancer, meaning those with low CDS scores have a 0.26% risk of having cancer [1]. Tick the relevant boxes in each category and add the points together to give the total score. A Cancer Dysphagia Score of ≥ 5.5 should proceed to urgent straight to test (STT) endoscopy if fit. A Cancer Dysphagia Score of < 5.5 must be referred via GASTRO REFERRAL. Patients will still get an OGD but in a less urgent time frame.

How to refer

All referrals must be made via the NHS e-Referral Service (eRS) using the Urgent Suspected Upper GI Oesophageal/Gastric Cancer (USC) referral form. Please attach relevant scan reports to referral.

Please include a clear clinical narrative to aid with timely and appropriate triage. Referrals without sufficient clinical information may be difficult to triage and could result in patient delays.

Required investigations

Please ensure prior to or within 3 months of referral, where possible, that patients have the following to aid clinical triage:

• U&Es inc. eGFR
• Minimum of 2 previous weight readings in the last year

Important information for patients

Please inform the patient this is an urgent suspected cancer referral.

Provide urgent suspected cancer information (CRUK Your USC referral) as leaflet or via Accurx.

Confirm availability and any access or communication needs at the point of referral.

What to do when patient does not meet USC criteria:

If your patient does not fit the criteria above, consider non-urgent straight to test endoscopy, via routine gastroenterology referral, to assess (as per NICE CKS guidance) [2]:

• People aged 55 years or over with:
  • Treatment-resistant dyspepsia, or
  • Upper abdominal pain with low haemoglobin levels, or
  • Raised platelet count with any of:
    • Nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
  • Nausea or vomiting with any of:
    • Weight loss, reflux, dyspepsia, upper abdominal pain
• Haematemesis: where the patient is haemodynamically stable, small amounts, low risk (G-B score)

Referral forms and pathways

USC Upper GI oesophageal/gastric referral form (blank)

Links and documents

USC Upper GI Hepato-pancreato-biliary page

[1] Supporting evidence for Cancer Dysphagia Score

[2] NICE CKS: Referral for suspected GI tract (upper) cancer

CRUK Patient Information (CRUK Your USC referral)

Authors:October 2026

Dr Miyah Khela

Dr Hazel Blanchard