Colorectal (lower GI) 2WW


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


When referring,

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, NOAC (Rivaroxaban etc.),Insulin


Referral Criteria

Colorectal cancer

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)

Advice regarding patients where NICE NG12 currently suggests faecal occult blood testing (currently not available)

  • Aged 50 and over with abdominal pain OR weight loss: Seek advice if concerned or refer to clinic if needed.
  • Aged under 60 with change in bowel habit: Seek advice if concerned or refer to clinic if needed.
  • Aged under 60 iron-deficiency anaemia:

Anal cancer

  • unexplained anal mass or unexplained anal ulceration (consider)

Referral Instructions

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

e-Referral selection:

  • 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

Referral Forms

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


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