GPAtlas🧭 When to suspect
Suspect colorectal cancer in any adult with a persistent change in bowel habit, unexplained rectal bleeding, iron-deficiency anaemia, or a palpable abdominal or rectal mass – and in older adults with unexplained weight loss or abdominal pain. Most patients present in primary care with symptoms that overlap heavily with benign disease, so the central skill is to use a quantitative faecal immunochemical test (FIT) to triage who needs a suspected cancer pathway referral (an appointment within 2 weeks; the former 2-week-wait, or 2WW, pathway), while recognising the findings that bypass FIT and warrant direct referral.
The FIT result is reported in micrograms of haemoglobin per gram of faeces (µg Hb/g); a result of ≥10 µg Hb/g is the threshold for referral. Suspect anal cancer in a person with an unexplained anal mass or ulceration.
| Any age – offer FIT for | By age – offer FIT for |
|---|---|
|
• An abdominal mass |
• Aged ≥40 with unexplained weight loss and abdominal pain |
|
• A change in bowel habit |
• Aged <50 with rectal bleeding and abdominal pain or weight loss |
|
• Iron-deficiency anaemia |
• Aged ≥50 with unexplained rectal bleeding, abdominal pain or weight loss |
|
• Aged ≥60 with anaemia even in the absence of iron deficiency |
• Refer directly on a suspected cancer pathway – no FIT needed – for a rectal mass, an unexplained anal mass, or unexplained anal ulceration.
• Offer a symptomatic FIT even if a recent NHS bowel cancer screening FIT was negative, and arrange extra help to return the sample where someone needs it.
Source: NICE NG12 · NICE HTG690
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