Colorectal (lower GI) 2WW


This guidance covers the referral of a patient who presents with symptoms suggestive of colorectal or anal cancer to a team specialising in the management of lower gastrointestinal cancer, depending on local arrangements.

In a patient with equivocal symptoms who is not unduly anxious, it is reasonable to 'treat, watch and wait'.

  • If you have concerns about a patient's symptoms and/or signs, consider a discussion with the local specialist.
  • GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.
  • Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network


When referring,

Important Information for the consultant to enable triage straight to test:

  • It is very helpful to have Hb, HbA1c, U&E's and a stool sample for MCS checked within last 6 weeks. If the patient has iron-deficiency anaemia a ferritin level would also be useful. If the patient has diarrhoea testing should ideally include B12, folate, TFTs, TTG, LFTs, calcium and plasma viscosity.

Is the patient on any of the following medications?

  • Asprin, Clopidogrel /Prasugrel etc ., Warfarin, DOAC (Rivaroxaban etc.),Insulin


Referral Criteria

Colorectal cancer

Aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings (consider):

  • abdominal pain;
  • change in bowel habit;
  • weight loss;
  • iron-deficiency anaemia (Hb and ferritin within the past four weeks would be extremely helpful)

Aged 40 and over with unexplained weight loss and abdominal pain

Aged 50 and over with unexplained rectal bleeding

Aged 60 and over with either of:

  • iron-deficiency anaemia or
  • changes in bowel habit
  • rectal or abdominal (but not pelvic) mass (consider)
Anal cancer
  • unexplained anal mass or unexplained anal ulceration (consider)
Faecal Immunochemical Test (qFIT)

GP's across the South West of England are now able to access the Faecal Immunochemical Test a new diagnostic test for the assessment of patients presenting with lower abdominal symptoms, who are classed as "low risk" but not "no risk," of cancer.

The test should be offered to patients without rectal bleeding, who are:

  • Over 50 with unexplained abdominal pain or weight loss
  • 50 to 60 with changes in bowel habit or iron-deficiency anaemia
  • 60 or over with anaemia without iron deficiency

Please see full guidance on the Implementation of the Faecal Immunochemical Test (qFIT) here.

Referral Instructions

From the 11th December 2017 the RD&E will only take 2WW referrals via the NHS e-Referral Service for Lower GI. GPs will be able to send their referrals to us by using new functionality called a Referral Assessment Service (RAS)

Please ensure you include:

  • The patient's NHS number
  • Tell the patient that this is an urgent referral and they will be seen within 14 days

e-Referral selection:

  • Specialty: 2WW
  • Clinic type: 2WW Lower GI
  • Service: Two Week Wait Colorectal Surgery / Lower GI- RAS-RDE-RH8

The referral will be graded by a Clinician, patients will be booked into either a consultant clinic or day case procedure appointment. RD&E will advise the patient if their appointment date and time.

For any patients that you are unable to process through NHS e-Referral please contact the

Referral Forms

Microtest: Please use No Merge Fields as a Microtest version is currently unavailable.

Suspected Lower GI cancer referral form - No merge fields

Suspected Lower GI cancer referral form - Emis WEB

Suspected Lower-GI cancer-referral form - Systmone

Last updated: 23-06-2020


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