lower GI cancer (NICE guidance - urgent referral for suspected cancer)

Last edited 05/2020 and last reviewed 09/2023

Colorectal cancer

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:

• they are aged 40 and over with unexplained weight loss and abdominal pain or
  
  
• they are aged 50 and over with unexplained rectal bleeding or
  
  
• they are aged 60 and over with:
  • iron-deficiency anaemia or
  • changes in their bowel habit, or
    
    
• tests show occult blood in their faeces

If rectal or abdominal mass:

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in people with a rectal or abdominal mass

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:

• abdominal pain
• change in bowel habit
• weight loss
• iron-deficiency anaemia.

Anal cancer

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for anal cancer in people with an unexplained anal mass or unexplained anal ulceration.

Use of FIT (Faecal Immunochemical Test) to identify possible colorectal cancer:

offer FIT to assess for colorectal cancer in adults without rectal bleeding who:

• are aged 50 and over with unexplained:
  • abdominal pain or
  • weight loss,
    
    
• or are aged under 60 with:
  • changes in their bowel habit or
  • iron-deficiency anaemia,
    
    
• or are aged 60 and over and have anaemia even in the absence of iron deficiency

Reference:

1. NICE (June 2015). Referral Guidelines for Suspected Cancer.