Reviewed on : 2 Feb 2021

Reviewed by : GP Gateway Editor

Expires : 2 Feb 2023

TWO WEEK REFERRAL SERVICES – GI LOWER

Indications for an urgent referral for a suspected new malignancy are shown below – see preview of document

Pre-investigations required:

• Digital Rectal Examination.
• FBC (Hb and Ferritin), LFTs, and U&Es at time of referral, unless taken during the preceding 1 month.
• FIT testing should now be requested at time of referral (see below)

Exemptions:

Rectal Bleed Clinic New symptoms of bright red rectal bleeding should be referred to the respective Rectal Bleed Clinic or Colorectal Clinic unless there is an additional reason to suspect colorectal cancer.

Referring patients who meet 2WW criteria

The 2WW Lower GI form has a dual-purpose allowing referring clinician to select appropriate NG12 clinical criteria and also generate a request to order a FIT.

Please tick this box as it allows secondary care to prioritise and book patients for colonoscopies and other diagnostic tests, for example CT Colonography (CTC).

Recent bloods (EGFR / U&Es) in the last 3 months are required before CTC or Colonoscopy.

Please provide results or where possible arrange for the patient to have appropriate blood test.

Please send the referral form directly via eReferral AND Email to uhc-tr.fitbcs@nhs.net

If you do NOT email the form to uhc-tr.fitbcs@nhs.net a testing kit will NOT be posted to the patient.

Please remind patients to complete their FIT as soon as possible. A leaflet explaining how to collect a sample will be included with the testing kit.

Preview of Lower GI 2WW Form

Safety Netting During the COVID-19  Recovery Phase (Cancer Research UK CRUK)

Follow link for information

Referring symptomatic patients who DO NOT meet the 2ww criteria.

The referral form can be seen here  or alternatively see Faecal Occult Blood Testing (FIT) – GP Gateway Page

Follow this link to a video explaining the role of FIT in the diagnostic pathway for bowel cancer

FIT Testing

FIT Testing – follow link to GP Gateway Page

FIT can be requested for symptomatic patients who do not meet the criteria for referral on the colorectal cancer 2WW pathway.

Several lower gastrointestinal symptoms can suggest colorectal cancer, including rectal bleeding, a change in bowel habits, weight loss, anaemia, abdominal pain, and blood in stools (faeces).

Where blood in stools is not visible (faecal occult blood) FIT tests can be used to detect its presence.

If patients with clinical indications of a malignancy do not fit above criteria then please discuss with the respective Lower GI consultant

All 2WW referrals should be made through the NHS eReferral Service (previously known as Choose & Book).

Consider handing the patient a Cancer Research UK Information Sheet – follow link