Reviewed on : 4 Apr 2016

Reviewed by : Manjari Bollu, GP Gateway Editor

Expires : 4 Apr 2018

TWO WEEK REFERRAL SERVICES – GI – LOWER: ARDEN CANCER NETWORK

Indications for an urgent referral for a suspected new malignancy are:

• 40 years + with unintentional clinically significant weight loss (>5% in the last 6 months) and abdominal pain
• Under 50 years with rectal bleeding and either abdominal pain, iron-deficiency anaemia – below 120 (women) or 130 (men) ,change in bowel habit to looser stool and/or increased frequency of defecation persisting for 6 weeks or more , or weight loss*
• 50 years with unexplained rectal bleeding
• 60 years + with iron-deficiency anaemia – below 120 (women) or 130 (men) or changes in bowel habit to looser stool and/or increased frequency of defecation persisting for 6 weeks or more
• ALL AGES with unexplained rectal or abdominal mass
• ALL AGES with an unexplained anal mass or unexplained anal ulceration

*Based on WHO threshold for anaemia (women anything below 120, men anything below 130).

Pre-investigations required of G.P: Digital Rectal Examination. Please arrange FBC (Hb and Ferritin), LFTs, and U&Es at time of referral, unless taken during the preceding 1 month.

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

NOTE: 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 and book).