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Colorectal Screening – Information for GPs

Referral Criteria / Commissioning position

Refer to secondary care via 2 week wait route for patients with:

  • definite palpable right sided abdominal mass probably involving large bowel
  • definite intraluminal (not pelvic) rectal mass. Perform PR to identify
  • unexplained iron deficiency anaemia with:
  1. Hb < 11g/dl in men
  2. Hb < 10g/dl in non-menstruating women
  3. 40-60 years old with persistent (>6 weeks) rectal bleeding and a change in bowel habit to looser/more frequent stools
  4. 60 years or over with persistent (>6 weeks) rectal bleeding (in absence of anal symptoms) and/or change to looser/more frequent stools

‘High Risk’ – warrants immediate referral to colorectal surgeon:

  • HNPCC (Hereditary Non-Polyposis Colon Cancer
  1. Defects in mismatch repair genes leading to increased survival of cells with mutated DNA
  2. Mutations result in increased prevalence of colonic carcinoma plus endometrium, ovarian, stomach, upper urothelial tract and biliary tree cancers
  3. Suspect in patients with 3 or more First degree relatives with 2 generations involved and one cancer diagnosed below the age of 50
  • FAP (Familial Adenomatous Polyposis)
  1. Defect in FAP gene, one of the key mutations in the multi-hit cascade of a cell as it progresses from normal to colorectal cancer cell
  2. Suspect in any patient with first degree relative with FAP or other genetic colorectal cancer condition
  • Patients with UC or Crohn’s colitis for >10 years

‘Moderate Risk’ – refer to genetic counselling service any patient with:

  • First degree relative colorectal cancer <50 years old
  • 2 First degree relatives with colorectal cancer at any age

Investigations prior to referral


Information to include in referral letter

  • Description of condition and duration
  • Treatments and interventions tried including the results
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history including family history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient Information Leaflets

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