Reviewed on : 4 Jun 2021

Reviewed by : Luke Hamer Communications Manager – Cancer and Long Term Conditions & GP Gateway Editor

Expires : 4 Jun 2023

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

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.

ALL patients referred for suspected Lower GI cancer should have a FIT test before referral, and the result included on the 2WW form.

If there is insufficient time to wait for FIT results you should indicate that a FIT has been sent to the patient and the results are pending.

Pre-investigations required:

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

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 stress the importance to patients that they need to complete their FIT as soon as possible. A leaflet explaining how to collect a sample will be included with the testing kit.

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

FIT results of more than 10 are deemed positive – patient has a 1 in 4 chance of Lower GI cancer.

When FIT is less than 10 it suggests a low probability of Lower GI cancer, although these do occur. Patients with bowel cancer and a FIT less than 10 often have other symptoms.

Preview of Lower GI 2WW Form

Follow this link to a video walkthrough of the Lower GI – 2WW referral form and Symptomatic FIT request 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

For information on referring symptomatic patients who do not meet the 2WW criteria, visit the 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

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

FIT Testing

FIT Testing – follow link to GP Gateway Page