Haematological Cancers

Urgent suspicion of cancer referral

  • Blood count/film reported as suggestive of acute leukaemia or chronic myeloid leukaemia*
  • Lymphadenopathy (>2cm) persisting for 6 weeks or increasing in size or generalised (HIV status should always be checked if generalised)
  • Hepatosplenomegaly in the absence of known liver disease
  • Bone pain associated with a paraprotein and/or anaemia
  • Bone x-rays reported as being suggestive of myeloma
  • The following clinical features may also merit urgent referral:
    • fatigue
    • night sweats
    • weight loss
    • itching
    • bruising
    • recurrent infections
    • bone pain
    • polyuria and polydipsia (hypercalcaemia)

* will normally be identified in the labor atory and communicated to the clinician for management to be agreed.l

Good practice points

  • For people presenting with non-specific symptoms, the clinician should always consider checking human immunodeficiency virus (HIV) status along with other routine investigations
  • Routine tests and investigations should be repeated at least once if a person’s condition remains unexplained
  • If myeloma is suspected, urine as well as serum electrophoresis should be performed

Primary care management

CLL in an older person should be discussed with a local haematologist but many cases do not require detailed haematological review.

Asymptomatic monoclonal gammopathy may be followed up in primary care depending on local arrangements – consider discussion with a haematologist if any concern.

Full Guideline