** UPDATE** Important Change to Suspected Lower GI Cancer Referrals

Diagnostic capacity for suspected lower GI cancer referrals is extremely limited during the COVID-19 pandemic. Given this, any diagnostic capacity must be prioritised to patients who show the highest risk of suspected colorectal cancer, which is why the following changes, mandated by NSHE, have been made.

All patients suspected of having a lower GI cancer (i.e. meeting NICE 2WW criteria) must now have a FIT test performed before a referral should be made, except in cases of unexplained anal or rectal mass, or anal ulceration who should be referred irrespective of FIT.


FIT of ≥10µg/g are positive and should be referred on 2WW.

FIT of <10µg/g, FIT of <10μg/g indicate a low probability of bowel cancer (99.6% chance that the patient does not have colorectal cancer).


If you are still suspicious of cancer, you should consider:

1) Safety netting and review at 4-6 weeks to consider need for referral if concerning symptoms persist, either LGI 2WW if the patient meets NG12 criteria or routinely if they do not;

2) Consider an alternative suspected cancer pathway that may be more appropriate for the patients symptoms e.g. upper GI, urological, gynaecological or to Rapid Diagnostic Centre (RDC);

3) Seeking advice from a specialist via Advice & Guidance or a similar service;

4) Refer on LGI 2WW pathway but with FULL clinical information included.


Further information can be found in the attached one page.

The suspected lower GI cancer referral form has been updated in light of these changes. You can find a copy of this, as well as further information, on this website: https://www.healthylondon.org/resource/covid-19-cancer-referral-resources


DXS has also been updated with these changes.

Please don’t hesitate to contact england.tcstlondon@nhs.net if you have any questions regarding these changes.

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