Synopsis
Recognise colorectal cancer across bleeding, bowel-habit, anaemia, abdominal and obstructive presentations, apply current symptomatic FIT recommendations, and escalate masses or emergencies without delay.
- Rectal bleeding, persistent bowel-habit change, weight loss, abdominal pain and iron-deficiency anaemia can occur alone or together.
- Offer quantitative FIT for the adult symptom groups specified by NICE NG12 and record who will review the value.
- Refer on the suspected colorectal-cancer pathway when FIT is at least 10 micrograms haemoglobin per gram of faeces.
Key red flags
Distension with vomiting and absolute constipation, peritonism, continuing large-volume rectal bleeding or circulatory compromise changes the problem from outpatient cancer triage to an emergency.
Investigation priorities
Stratify symptomatic colorectal-cancer risk in the NICE pathway.
Management branches
A 63-year-old has eight weeks of looser stool, fatigue and intermittent blood mixed with stool. Examination finds no mass; haemoglobin is 108 g/L with ferritin 7 micrograms/L and FIT is 34 micrograms haemoglobin per gram.
- Check observations and ask about heavy bleeding, vomiting, distension and passage of flatus; stable physiology and absence of obstruction allow an urgent outpatient pathway.
- Document the symptom duration, weight trend, family history and medicines, then complete abdominal and consented digital rectal examination without treating the normal examination as exclusion.
A 74-year-old with months of narrowing stool now has marked distension, colicky pain, faeculent vomiting, absolute constipation, pulse 122/min and new kidney injury.