Guidelines for urgent referral of patients with suspected lower GI cancer

It is recommended that these symptom and sign combinations when occurring for the first time should be used to identify patients for urgent referral under the two week standard:

All Ages

A definite palpable right-sided abdominal mass.
A definite palpable rectal (not pelvic) mass
Rectal bleeding WITH a change in bowel habit to looser stools and/or increased frequency of defecation persistent for 6 weeks

Over 60 years

Rectal bleeding persistently WITHOUT anal symptoms*

Change of bowel habit to looser stools and/or increased frequency of defecation, WITHOUT rectal bleeding and persistent for six weeks.

Age 60 years is considered to be the maximum age threshold. Local Cancer Networks may elect to set a lower age threshold (eg 55 years or 50 years)

Any Age

Iron deficiency anaemia WITHOUT an obvious cause (Hb < 11 g/dl in men or < 10 g/dl in postmenopausal women).

NB. Patients with the following symptoms and no abdominal or rectal mass, are at very low risk of cancer:

Rectal bleeding with anal symptoms*
Change in bowel habit to decreased frequency of defaecation and harder stools.

Abdominal pain without clear evidence of intestinal obstruction.

* Anal symptoms include soreness, discomfort, itching, lumps and prolapse as well as pain.

Source: Department of Health urgent referral guidelines