HNY Policy and Pathway Repository - North Yorkshire

Suspected GI / colorectal cancer

None provided

OGD if

• Dysphagia (any age)
• >55 weight loss AND abdominal pain, dyspepsia or reflux

OGD and colonoscopy if

• IDA male
  OR
• Post-menopausal female

(Iron deficient, FIT <10 - advise urgent CR referral)

Lower GI endoscopy if

FIT 10 & above AND:

• Rectal bleeding
• Persistent CIBH
• Unexplained weight loss AND abdominal pain

Contrast enhanced CT abdomen / pelvis if

• Palpable abdominal mass

Colorectal F2F clinic if

• Palpable rectal anal mass
  AND/OR
• Moderate to severe frailty or not suitable for STT investigations

(See also colorectal pathway information below)

Ask GP to remove from suspected cancer pathway and refer to colorectal if FIT <7 and normal Hb and persistent CR symptoms Return to GP with advice if Does not meet GI NG 12 criteria (non-IDA)  (If appropriate, consider SNSP pathway)

 

Colorectal cancer pathway

Person presenting with undiagnosed abdominal symptoms of suspected coloractal cancer such as:

• Unexplained weigh loss and abdominal pain
• Unexplained rectal bleeding
• Persistent change in bowel habit
• Abdominal mass
• IDA

After physical examination refer via colorectal cancer pathway if:

• Abdominal mass found (provide FIT)
• Anal / rectal mass or anal ulceration (no FIT required)
• Patient concerning symptoms (unable to complete RT)

GP to provide FIT AND orders FBC, U&E, Ferritin and any other tests considered relevant at the point of examination as per NG12 guidelines:

Colorectal cancer pathway if:

• FIT ≥ 10 

If FIT <10 then options are:

• If has non-persistent low risk symptoms and all other investigations normal
  • Give patient information and support to self manage with advice to re-present to GP if symptoms change:
• If has less concerning persistent CR symptoms (e.g. CIBH, interim rectal bleeding and all other investigations normal
  • Refer on to appropriate routine pathway option to repeat FIT +/- FCP if appropriate
• If still has clinical concen of cancer, consider ordering additional tests such as CA125(F), PAS(M), CRP, LFT, TFT, coeliac screen, HbA1C (Safety Netting)
  • Raised CA125 - gynae cancer pathway
  • Raised PSA - urology cancer pathway
  • SNSP cancer pathway

Expected timeline for lower GI cancer pathway

• Day 0: GP refers on suspected GI cancer pathway using electronic referral form (via e-RS)
• Day 0-3: Referral triaged by senior clinican
• Day 7-14:
  • Endoscopic investigation
  • Imaging
  • Clinic assessment
• Day 14-21: Assessed as either -
  • Cancer / suspected cancer
  • No cancer - discharged
• Day 21: Appropriate staging investigations & MDT
• Day 28: Cancer confirmed or excluded

Suspected GI cancer triage guide and pathway flowchart (also below)

Primary care suspected colorectal cancer pathway flowchart (also below)

• Harrogate and District