Suspected Cancer: 2 Week Wait

If clinical concerns but doesn't appear to fit criteria, consider using A&G through ERS.

FIT Exclusion
All ages – Rectal/Anal mass or ulceration.

FIT inclusion but trigger LGI 'suspicious of cancer' referral simultaneously
Abdominal Mass.

FIT inclusion but await result before referral decision
All other NG12 'suspicious of cancer' symptom(s) plus FIT result ≥ 10

  • Aged ≥40 y with unexplained weight loss and abdominal pain
  • Aged ≥50y with unexplained rectal bleeding
  • Aged ≥60y with:
    • Iron deficiency anaemia (N.B. in draft guidance NICE defined this as Hb ≤12 in men and Hb ≤11 in women – this was based on primary care research that showed these lower thresholds would pick up more cases – it was removed from final guidance and left to our discretion)
    • Changes in their bowel habit.
  • 50y and rectal bleeding with any of the following unexplained symptoms or findings:
    • Abdominal pain.
    • Change in bowel habit.
    • Weight loss.
    • Iron deficiency anaemia.
  • Aged 50y and over and have abdominal pain or weight loss
  • Aged <60y and have change in bowel habit or iron deficiency anaemia
  • Aged 60y and over and have anaemia - even in absence of iron deficiency

FIT >10 Refer 2ww Lower GI.

FIT <10 and ongoing clinical concern, consider Advice and Guidance or alternative pathway.

Cancer Less Likely

Fresh rectal bleeding possibly with pain / perianal symptoms & no alarm symptoms, consider piles / fissure / prolapse.

  • Full Blood Count, Ferritin and Digital Rectal Examination.

Refer: If no identifiable cause or concerns persist, consider referral to colorectal surgery.

Significant Weight Loss Only?

Non Site-Specific Pathway