Reviewed on : 22 Nov 2018

Reviewed by : GP Gateway Editor

Expires : 22 Nov 2020

TWO WEEK REFERRAL SERVICES – GI LOWER

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:

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.

FIT Testing – follow link

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