This guidance covers the referral of a patient who presents with symptoms suggestive of colorectal or anal cancer to a team specialising in the management of lower gastrointestinal cancer, depending on local arrangements.
In a patient with equivocal symptoms who is not unduly anxious, it is reasonable to 'treat, watch and wait'.
- If you have concerns about a patient's symptoms and/or signs, consider a discussion with the local specialist.
- GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.
- Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network
Last updated: 26-05-2020
Important Information for the consultant to enable triage straight to test:
- It is very helpful to have Hb, HbA1c, U&E's and a stool sample for MCS checked within last 6 weeks. If the patient has iron-deficiency anaemia a ferritin level would also be useful. If the patient has diarrhoea testing should ideally include B12, folate, TFTs, TTG, LFTs, calcium and plasma viscosity.
Is the patient on any of the following medications?
- Asprin, Clopidogrel /Prasugrel etc ., Warfarin, DOAC (Rivaroxaban etc.),Insulin
Aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings (consider):
- abdominal pain;
- change in bowel habit;
- weight loss;
- iron-deficiency anaemia (Hb and ferritin within the past four weeks would be extremely helpful)
Aged 40 and over with unexplained weight loss and abdominal pain
Aged 50 and over with unexplained rectal bleeding
Aged 60 and over with either of:
- iron-deficiency anaemia or
- changes in bowel habit
- rectal or abdominal (but not pelvic) mass (consider)
- unexplained anal mass or unexplained anal ulceration (consider)
Faecal Immunochemical Test (qFIT)
GP's across the South West of England are now able to access the Faecal Immunochemical Test a new diagnostic test for the assessment of patients presenting with lower abdominal symptoms, who are classed as "low risk" but not "no risk," of cancer.
The test should be offered to patients without rectal bleeding, who are:
- Over 50 with unexplained abdominal pain or weight loss
- 50 to 60 with changes in bowel habit or iron-deficiency anaemia
- 60 or over with anaemia without iron deficiency
Please see full guidance on the Implementation of the Faecal Immunochemical Test (qFIT) here.
The GP should use e-Referral Service to book an appointment or send the referral.
Please ensure you include:
- The patient's NHS number
- Tell the patient that this is an urgent referral and they will be seen within 14 days
- Specialty: 2WW
- Clinic type: 2WW Lower GI
- Service: DRSS-Western-2WW Lower GI - Devon CCG-15N
For any patients that you are unable to process through NHS e-Referral please contact the firstname.lastname@example.org
Suspected Lower GI cancer referral form - No merge fields
Suspected Lower GI cancer referral form - Emis WEB
Suspected Lower GI cancer referral form - Microtest
Suspected Lower GI cancer referral form - Systmone
Western locality >
2 week wait >
Colorectal (lower GI) 2WW
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