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  Two-Week Wait Rule - Suspected Cancer  
Referral Guidelines for Suspected Cancer (Two week wait rule) based on NICE Guidance 2005
Last Updated October 2012.

Lower Gastrointestinal Cancer

Urgent Referral

Refer urgently patients

  • aged >40 years reporting rectal bleeding with a change of bowel habit 6 weeks
  • aged >60 years with rectal bleeding persisting 6 weeks without anal symptoms
  • aged >60 years with a change in bowel habit ≥ 6 weeks
  • of any age with a right lower abdominal mass consistent with involvement of the large bowel
  • of any age with a palpable rectal mass (intraluminal and not pelvic; a pelvic mass outside the bowel would warrant an urgent referral to urology or gynaecology)
  • iron deficiency anaemia without obvious cause (Hb < 11g/dl for men or <10g/dl for women)


Patients with the following symptoms and no abdominal or rectal mass are at very low risk of cancer

  • rectal bleeding with anal symptoms (soreness, discomfort, itching, lumps and prolapse as well as pain)
  • change in bowel habit to decreasing frequency of defaecation and harder stools
  • abdominal pains without clear evidence of intestinal obstruction




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Last Update: 31 January 2008