Gastrointestinal

Pts at high risk colorectal cancer	Aged more than 50 and Rectal bleeding and change in bowel habit for more than 6 weeks Rectal bleeding without anal symptoms ( Loose stools for more than 6 weeks Anaemia, iron deficient, Hb less than 10 Obvious abdominal or rectal mass
Soon	Patients aged less than 50 with high risk symptoms as before or... Low risk symptoms Rectal bleeding and change in bowel habit for less than 6 weeks Rectal bleeding and anal symptoms Constipation (decreased frequency, increased hardness) Abdominal pain Prolonged history of recurrent symptoms
Routine	Anal canal symptoms Incontinence Prolapse Family history: 3 relatives with colorectal cancer or 2 relatives with colorectal cancer and 1 relative with endometrial, gastric, uro-epithelial or small intestine cancer (1 first degree relative. 1 under 50 and at least 2 generations affected)

The patient should be made aware that they will be allocated to the appropriate clinic/test by the hospital consultant on receipt of the completed referral form.
The relevant information for their allocated visit will be sent out with their appointment.
Some indication should be given as to the time-scale for the priority of their referral, eg within 2 weeks for an urgent referral.
The patient should be aware of why their symptoms have been prioritized, and the necessity of urgency or the relevance of any delay on their condition.

Referral priority	Urgent/soon/routine
Index suspicion of cancer	Definitely not ................ definitely cancer
Colorectal symptoms	Duration of symptoms Rectal bleeding Change in bowel habit Anal symptoms Rectal mass Incontinence Abdominal pain

Pedigree	Lifetime risk of colorectal cancer
Population risk	1 in 30
1 first degree relative	1 in 17
1 first degree and 1 second degree relative	1 in 12
1 first degree relative aged <45	1 in 10
2 first degree relatives	1 in 6

Colorectal problems