When should I consider referring a patient with suspected carcinoid syndrome to a specialist?

Consider referring a patient with suspected carcinoid syndrome to a specialist when there is clinical suspicion of a neuroendocrine tumour presenting with symptoms such as flushing, diarrhoea, wheezing, or other features suggestive of carcinoid syndrome that cannot be explained by other diagnoses. Referral should be made promptly once suspicion arises, ideally within 1 working day, to ensure timely specialist assessment and investigation.

If there is uncertainty about the interpretation of symptoms or whether referral is needed, discuss the case with a specialist (e.g., by telephone or email) to clarify the need for referral.

When referring, include all relevant clinical information and indicate the urgency of the referral. Provide the patient with information about the referral process, what to expect, and support available while waiting for the specialist appointment.

These principles align with NICE guidance on suspected cancer recognition and referral, which applies to rare cancers including neuroendocrine tumours causing carcinoid syndrome, emphasizing early referral for suspected cancer symptoms and safety netting in primary care NICE NG12.