GPAtlas🧭 When to suspect
Suspect colorectal cancer in any adult with:
• A persistent change in bowel habit
• Unexplained rectal bleeding
• Iron-deficiency anaemia
• A palpable abdominal or rectal mass
• Unexplained weight loss or abdominal pain in older adults
Most patients present in primary care with symptoms that overlap heavily with benign disease. The central skill is to:
• Use a quantitative faecal immunochemical test (FIT) to triage who needs a suspected cancer pathway referral (previously the two-week wait).
• Recognise 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 |
|---|
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• An abdominal mass |
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• A change in bowel habit |
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• Iron-deficiency anaemia |
| By age – offer FIT for |
|---|
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• Aged ≥40 with unexplained weight loss and abdominal pain |
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• Aged <50 with rectal bleeding and abdominal pain or weight loss |
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• Aged ≥50 with unexplained rectal bleeding, abdominal pain or weight loss |
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• Aged ≥60 with anaemia even in the absence of iron deficiency |
• 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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