If you have symptoms that could indicate cancer, your doctor may use an urgent referral pathway to ensure you are seen by a specialist quickly. This system, known as the “2-week wait,” is part of the UK’s National Health Service (NHS) approach to potential cancer diagnoses. Its purpose is to expedite the assessment process for concerning symptoms.
An urgent referral does not mean you have cancer, and most people referred this way are found not to have the disease. The system is cautious, aiming for either early reassurance or a faster diagnosis and treatment if cancer is confirmed. This initial two-week period is part of a broader “Faster Diagnosis Standard” in England, which aims to provide a definitive diagnosis or rule out cancer within 28 days of the referral.
Symptoms Leading to a Referral
A general practitioner’s (GP) decision to make an urgent referral is guided by specific criteria, such as guidelines from the National Institute for Health and Care Excellence (NICE) in the UK. These outline “red flag” symptoms that, while often caused by less serious conditions, warrant prompt investigation to rule out cancer. The nature of these symptoms often points toward a specific type of specialist for assessment.
For instance, respiratory symptoms are a common reason for referral. A persistent cough lasting more than three weeks, unexplained shortness of breath, or coughing up blood may prompt a referral to a chest clinic for possible lung cancer. These symptoms are evaluated alongside the patient’s age and smoking history.
Gastrointestinal symptoms also feature prominently in referral guidelines. A specialist assessment for colorectal cancer may be triggered by:
- Unexplained and persistent changes in bowel habits, especially in those over 60
- The presence of blood in the stool without a clear reason, like hemorrhoids
- Persistent abdominal pain
- Unexpected weight loss
Other symptoms are linked to different areas of the body. An urgent referral may be made for a new lump in a breast, unexplained bleeding like blood in the urine, or difficult swallowing (dysphagia).
The Referral Process and Initial Appointment
Once your GP makes an urgent referral, the surgery sends it directly to the relevant hospital department. You should expect to be contacted by the hospital’s booking team by phone or letter to schedule your first appointment. The target is for this appointment to occur within two weeks of the referral, so ensure your GP has your correct contact details.
During this initial specialist appointment, the consultant will gather information to understand your symptoms. They will discuss your medical history, the symptoms you have been experiencing, and relevant lifestyle factors. This is followed by a physical examination tailored to your symptoms.
Depending on the suspected type of cancer, some initial diagnostic tests might be performed during this first visit. For example, a referral for a breast lump may lead to a “triple assessment,” including a physical exam, imaging scan, and biopsy in one appointment. For other symptoms, the first visit may involve simpler tests, with more complex investigations scheduled later.
Possible Outcomes After the Two-Week Wait
Following your initial consultation, the most reassuring outcome is that the specialist can rule out cancer. After an examination and any initial tests, the consultant may find your symptoms are caused by a non-cancerous condition. You would then be discharged from their care, often with advice to follow up with your GP.
Another outcome is a confirmed cancer diagnosis. The consultant will explain the findings and discuss the next steps, which involves planning further tests to understand the extent of the cancer before treatment can be finalized. You will be introduced to a clinical nurse specialist who will act as your main point of contact.
In many cases, the diagnosis remains uncertain after the first appointment, requiring more complex investigations. The two-week target applies only to seeing a specialist, not receiving a complete diagnosis. This means you may need to attend further appointments for procedures like CT scans, MRIs, or biopsies that fall outside the initial 14-day window.
Navigating Delays and Next Steps
While the system aims for a two-week timeframe, delays can occur. If you have not heard about your appointment within a week, contact your GP’s surgery to confirm the referral was sent. You can then contact the hospital’s appointments department or the Patient Advice and Liaison Service (PALS) for an update.
If your symptoms worsen or you develop new ones while waiting, contact your GP. New information may change the urgency or the type of specialist you need to see. Do not ignore persistent symptoms even if an investigation came back clear.
Keep a record of your symptoms and any communication with healthcare providers. Ask questions during appointments about timelines for test results or next steps. If you do not receive results by the expected date, follow up with the specialist’s secretary or your clinical nurse specialist.