Lower gastrointestinal cancer referral guidelines

Access our referral guidelines for lower gastrointestinal cancer, including anal and colorectal cancer.

About these guidelines

We have developed our Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:

Non urgent

Non urgent

Requires routine referral or tests.



Required within two weeks.

Very urgent

Very urgent

Required within 48 hours.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Anal cancer referral guidelines

Very urgent

Urgent referral

Consider urgent referral (appointment within two weeks) for people with either:

  • an unexplained anal mass
  • OR unexplained anal ulceration.

Colorectal cancer referral guidelines

Non urgent

Urgent referral

Urgently refer (appointment within two weeks) people:

  • aged 40 and over with unexplained weight loss and abdominal pain
  • aged 50 and over with unexplained rectal bleeding

aged 60 and over with either:

  • iron deficiency anaemia
  • OR alteration in bowel habit
  • who have positively tested for occult blood in their faeces.

Consider urgent referral (appointment within two weeks) for people:

  • of any age with a rectal or abdominal mass
  • aged under 50 with rectal bleeding and any of the following unexplained signs or symptoms:
  • abdominal pain
  • altered bowel habit
  • weight loss
  • iron deficiency anaemia.

Faecal immunochemical testing

Offer testing with quantitative faecal immunochemical tests (see the NICE diagnostics guidance on quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care) to assess for colorectal cancer in adults without rectal bleeding who:

  • aged 50 or over with unexplained:
  • abdominal pain
  • OR weight loss

aged under 60 with either:

  • changes in bowel habit
  • OR iron-deficiency anaemia
  • aged 60 or over with anaemia, even in the absence of iron deficiency.

Accompanying notes

If clinical concern persists, consider Faecal immunochemical testing in people who do not fall into the above categories, but who present with signs or symptoms that would benefit from further investigation.

Glossary of terms

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years.
  • Young people – people aged 16–24.
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result.
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary.
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks at the time of publication of the 2015 NICE guidance).

Legal disclaimer

Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.