Lower GI 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


REFERRAL GUIDELINES FOR SUSPECTED LOWER GI CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of lower GI cancer as detailed in the NICE guidance below.
  • In a patient with equivocal symptoms who is not unduly anxious, it is reasonable to 'treat, watch and wait'.
  • Only refer when patient is available to attend an appointment within the next 14 days.


  • Always carry out a digital rectal examination in patients with unexplained symptoms relating to the lower gastrointestinal tract.
  • Where symptoms are equivocal a full bllood count may help in identifying the possibility of colorectal cancer by demonstrating iron deficiency anaemia, which should then determine if a referral should be made and its urgency.
  • When referring, a full blood count may assist specialist assessment in the outpatient clinic.
  • When referring, no examinations or investigations other than abdominal and rectal examination and full blood count are recommended as this may delay referral.
  • Consider testing for occult blood in faeces to assess in adults without rectal bleeding who:
    • Aged >50 yrs with unexplained, abdominal pain or weight loss, or
    • Aged <60 with changes in bowel habit or iron-deficiency anaemia**, or
    • Aged >60 yrs and have anaemia even in absence of iron deficiency
    • ** Level of iron-deficiency anaemia is not stated in NICE guidance

*Creutzfeldt-Jakob Disease:

  • The CJD/CJDv risk assessment form should be completed for all patients undergoing endoscopy procedures and the outcome documented on the fast track referral form.
  • PLEASE NOTE: Currently MYHT does not provide FOB testing – you may consider using a Fast Track Referral

Please refer to NICE referral guidelines for suspected cancer


Referral Criteria

Urgent 2ww:

  • Colorectal Cancer
    • Aged 40 and over with unexplained weight loss and abdominal pain
    • Aged 50 and over with unexplained rectal bleeding
    • Aged 60 and over with:
      • Iron-deficiency anaemia
      • Changes in their bowel habit
    • Tests show occult blood in their faeces
  • Of any age: Rectal or abdominal mass
  • Aged under 50: Rectal bleeding and any of the following unexplained symptoms or findings:
    • Abdominal pain
    • Change in bowel habit
    • Weight loss
    • Iron-deficiency anaemia
  • Offer testing for occult blood in faeces to assess for colorectal cancer in adults without rectal bleeding who:
    • Are aged 50 and over with unexplained:
      • Abdominal pain
      • Weight loss
    • Are aged under 60 with:
      • Changes in their bowel habit
      • Iron-deficiency anaemia
    • Are aged 60 and over and have anaemia even in the absence of iron-deficiency
  • PLEASE NOTE: Currently Mid Yorkshire Hospitals Trust does not provide FOB testing – you may consider using a Fast Track Referral

Anal Cancer

  • Of any age:
  • Unexplained anal mass or unexplained anal ulceration

Risk Factors:

  • Offer patients with ulcerative colitis or a history of ulcerative colitis a follow-up plan agreed with a specialist in an effort to detect colorectal cancer in this high-risk group.
  • There is insufficient evidence to suggest that a positive family history of colorectal cancer can be used to assist in the decision about referral of a symptomatic patient.

Referral Instructions

Supporting information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA7 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document


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