Lower Gastrointestinal Cancer

Urgent Referral

Refer urgently patients

• aged >40 years reporting rectal bleeding with a change of bowel habit 6 weeks
• aged >60 years with rectal bleeding persisting 6 weeks without anal symptoms
• aged >60 years with a change in bowel habit ≥ 6 weeks
• of any age with a right lower abdominal mass consistent with involvement of the large bowel
• of any age with a palpable rectal mass (intraluminal and not pelvic; a pelvic mass outside the bowel would warrant an urgent referral to urology or gynaecology)
• iron deficiency anaemia without obvious cause (Hb < 11g/dl for men or <10g/dl for women)

NOTE:

Patients with the following symptoms and no abdominal or rectal mass are at very low risk of cancer

• rectal bleeding with anal symptoms (soreness, discomfort, itching, lumps and prolapse as well as pain)
• change in bowel habit to decreasing frequency of defaecation and harder stools
• abdominal pains without clear evidence of intestinal obstruction