Referral advice recommendation:General Practitioners (GP) should carefully establish whether the patient's signs or symptoms fulfil the criteria for urgent referral for suspected colorectal cancer, and act accordingly. Colonoscopy (or flexible sigmoidoscopy plus barium enema, if patients find colonoscopy unacceptable) should be used when symptoms suggest possible cancer of the right or transverse colon.
Patients with iron-deficiency anaemia (apart from menstruating women) should be referred for colonoscopy. People over the age of 50 with rectal bleeding of recent onset or other suspicious symptoms should have rectal examination and flexible sigmoidoscopy or colonoscopy; their symptoms should not be attributed to haemorrhoids until the possibility of colorectal cancer or adenomatous polyps has been excluded. General Practitioners (GPs) should be alert to the possibility that colorectal cancer can co-exist with haemorrhoids. It is important that investigations for bowel symptoms or anaemia should continue until the cause is found. The threshold for referral for investigation should be reduced if other members of the patient's family have had a diagnosis of colorectal cancer.
General Practitioners (GPs) should not refer patients with suspected colorectal cancer to a specific clinician (as opposed to a diagnostic clinic) who is not a core member of a colorectal cancer multi-disciplinary team.
Referral advice category:Urgent
Source guidance details
Issue date:June 2004
View all NICE referral advice recommendations from this guidance:
This page was last updated: 22 August 2012