When making an urgent suspected cancer (USC) referral (previously known as two-week waits or 2WW), please ensure your patient understands that they have been referred on a suspected cancer pathway and that they should make themselves available for diagnostic tests and outpatient appointments for the next 28 days.

Guidance for referring patients for suspected lower gastro-intestinal cancer, in summary is:

• GPs should continue to refer patients with suspected lower gastro-intestinal (GI) cancer on the current urgent suspected cancer (USC) form.
• GPs should undertake faecal immunochemical (FIT) testing in symptomatic patients in line with NICE guidelines. Exceptions are anal mass, rectal mass or anal ulceration; these patients should be referred directly (without a FIT test) onto the suspected lower GI cancer pathway.
• Patients who have had a negative or normal bowel screening result and present to their GP practice with possible suspected lower GI cancer symptoms should have a FIT test in primary care.

For further detail on FIT see the FIT section on the Right Test Right Time page.

Eligibility Criteria

Inclusions

• positive FIT with symptoms suggestive of cancer, where FIT ≥10 ug/g
• abnormal lower GI investigations (colonoscopy/flexible sigmoidoscopy/CT scan) suggestive of cancer
• unexplained rectal mass
• unexplained anal mass or anal ulceration

How to Refer