Synopsis
Recognise colorectal cancer across symptomatic, screening and emergency presentations, investigate without false reassurance, and coordinate stage-specific multidisciplinary treatment and surveillance safely.
- Right-sided cancers often present with iron-deficiency anaemia, fatigue, weight loss or a mass; left-sided lesions more often produce altered bowel habit, bleeding or obstruction.
- Rectal cancer may cause bright bleeding, tenesmus, urgency, incomplete evacuation or a palpable lesion on digital rectal examination.
- In symptomatic adults, quantitative FIT supports referral decisions, but a rectal or abdominal mass, obstruction, persistent unexplained symptoms or strong clinical concern must override a reassuring result.
Key red flags
Tenesmus, urgency, mucus, bleeding and a sense of incomplete evacuation should prompt inspection and digital rectal examination where appropriate, with urgent referral even if FIT is low when a mass is felt.
Investigation priorities
Triage eligible symptomatic people into the colorectal cancer pathway.
Management branches
New colorectal symptoms, unexplained iron deficiency, or a concerning examination finding.
- Take a site-focused history, examine the abdomen, inspect the anus where relevant and perform digital rectal examination for rectal symptoms when clinically appropriate.
- Request quantitative FIT according to the current symptomatic pathway, plus blood count and iron studies, without allowing testing logistics to delay referral for a mass, obstruction or marked concern.
Key medicines
Intravenous broad-spectrum antimicrobialsUse the local emergency intra-abdominal sepsis regimen with renal adjustment and early review.
Fluoropyrimidine-based systemic therapyRegimen, cycle timing and dose are calculated by the specialist oncology protocol.