Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Faecal immunochemical testing in symptomatic adults
Essential points for quick revision.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
Saved on this device
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Do not wait for FIT when examination or physiology already demands escalation
Do not allow waiting for FIT or a result below threshold to delay referral when there is a rectal mass, unexplained anal mass or ulceration, marked deterioration, obstruction, or persistent strong clinical concern.
Action: Send a rectal mass, unexplained anal mass or anal ulceration directly through the relevant suspected-cancer pathway without awaiting FIT. If there is obstruction, major bleeding or physiological compromise, arrange same-day emergency surgical assessment and begin resuscitation; persistent unexplained symptoms after a low or missing result require an owned secondary-care investigation plan.
Synopsis
Use quantitative FIT as a current NICE risk-stratification test for symptomatic adults, apply the 10 micrograms haemoglobin per gram threshold, and safety-net low or missing results against clinical concern.
Offer symptomatic FIT to adults of any age with an abdominal mass, change in bowel habit or iron-deficiency anaemia.
Also offer it from age 40 with unexplained weight loss plus abdominal pain, and under age 50 when rectal bleeding accompanies either unexplained abdominal pain or weight loss.
Offer FIT from age 50 with unexplained rectal bleeding, abdominal pain or weight loss, and from age 60 with anaemia even without proven iron deficiency.
Key red flags
Do not allow waiting for FIT or a result below threshold to delay referral when there is a rectal mass, unexplained anal mass or ulceration, marked deterioration, obstruction, or persistent strong clinical concern.
Investigation priorities
01
Quantitative FIT sampleFirst step
measure faecal haemoglobin concentration for risk stratification
Management branches
Worked case: applied faecal immunochemical testing in symptomatic adultsReach a specific decision and confirm it happened
A 71-year-old has an unexplained change in bowel habit, no palpable rectal mass and stable observations. The clinician plans quantitative FIT and must interpret the eventual numerical result against the current NICE referral threshold.
Confirm stable observations and absence of obstruction or a palpable mass, then record the exact NICE symptom indication before issuing the kit.
Explain single-sample collection, avoiding contamination and returning the device promptly; create a task so a missing sample is actively chased.
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 7 Sept 2026; clinical approval remains outstanding.