How should I approach the management of a patient with unintentional weight loss and no obvious cause after initial assessment?

Approach to management of unintentional weight loss with no obvious cause after initial assessment:

• Conduct a thorough assessment for additional symptoms, signs, or findings that may help clarify the most likely underlying cause, including possible cancers such as colorectal, gastro-oesophageal, lung, prostate, pancreatic, or urological cancer.
• Offer urgent investigations or refer urgently via a suspected cancer pathway if any additional symptoms or risk factors are identified.
• For patients aged 40 and over with unexplained weight loss and abdominal pain, offer quantitative faecal immunochemical testing (FIT) to assess for colorectal cancer.
• For adults under 50 with unexplained weight loss and rectal bleeding, and for those 50 and over with unexplained weight loss, offer quantitative FIT.
• For patients aged 40 and over who have ever smoked or have been exposed to asbestos, or who have unexplained cough, fatigue, shortness of breath, chest pain, or appetite loss, offer an urgent chest X-ray within 2 weeks to investigate for lung cancer or mesothelioma.
• In adults with unexplained splenomegaly or lymphadenopathy and weight loss, consider referral via a suspected cancer pathway for possible lymphoma.
• For women with unexplained weight loss, consider primary care testing including serum CA125 to investigate for ovarian cancer.
• For patients aged 60 and over with weight loss and symptoms such as diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation, or new-onset diabetes, consider urgent direct access CT or ultrasound to investigate for pancreatic cancer.
• For patients aged 55 and over with weight loss and raised platelet count or nausea/vomiting, consider non-urgent direct access upper gastrointestinal endoscopy to investigate for oesophageal or stomach cancer.

In summary, after initial assessment, the key is to identify any additional symptoms or risk factors that guide targeted urgent investigations or referrals to exclude serious causes, particularly cancer, following the NG12 suspected cancer guidelines ¹.