Publication - Advice and guidance

Scottish referral guidelines for suspected cancer: quick reference guide

Published: 22 Jan 2019
Community Health and Social Care Directorate
Part of:
Health and social care

User-friendly visual aid to the urgent referral criteria as well as routine referral criteria and primary care management and good practice points.

50 page PDF

3.0 MB

50 page PDF

3.0 MB

Scottish referral guidelines for suspected cancer: quick reference guide
Lower Gastrointestinal Cancer

50 page PDF

3.0 MB

Lower Gastrointestinal Cancer

Urgent suspicion of cancer referral - high risk features


Repeated rectal bleeding without an obvious anal cause

Any blood mixed with the stool

Bowel habit

Persistent (more than four weeks) change in bowel habit especially to looser stools - not simple constipation


Unexplained abdominal mass

Palpable ano-rectal mass


Abdominal pain with weight loss (also consider upper GI cancer)

Iron deficiency anaemia

Unexplained iron deficiency anaemia

Quantitative faecal immunochemical testing (qFIT) is being used in symptomatic patients in pilot projects in many Boards. Each has its own referral guidance which must now be used where available (see local guidance). This guideline will be further reviewed once a national strategy has been agreed.

An abdominal and rectal examination plus blood tests to assess renal function (in case of triage straight to CT colonography), liver function tests and to exclude anaemia and thrombocytosis should be performed on all people with symptoms suggestive of colorectal cancer. There is emerging evidence that thrombocytosis is a risk marker for underlying cancer, including colorectal, and this can facilitate appropriate triage in secondary care. A negative rectal examination, or a recent negative bowel screening test, should not rule out the need to refer. The carcinoembryonic antigen test should not be used as a screening tool.

Good practice points

  • Consider the possibility of ovarian cancer as per gynaecological cancers guideline
  • An abdominal palpation should be undertaken, CA125 blood serum level measured and urgent pelvic ultrasound scan carried out in:
  • any woman over 50 years who has experienced new symptoms within the last 12 months that suggest irritable bowel syndrome, or
  • women (especially those over 50 years) with one or more unexplained and recurrent symptoms (most days) of:
  • abdominal distension or persistent bloating
  • feeling full quickly or difficulty eating
  • loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency
  • change in bowel habit

Primary care management

  • Low risk features:
  • transient symptoms (less than four weeks)
  • patients under 40 years in absence of high risk features
  • Watch and wait (four weeks)
  • Assessment and review
  • Consider bowel diary
  • Appropriate information, counselling and agreed plan for review with GP
  • Refer if symptoms persist or recur

For genetics queries, please refer to regional guidance (see appendix).


Email: Cancer Access Team