Document type
Clinical pathways
East and North Hertfordshire
Output type
Clinical Pathways
Colorectal Suspected Cancer PathwayLower GI & FIT Process Pathway for Primary Care pathway

Lower GI/Colorectal Cancer Suspected

General information:

Check with each Trust's referral forms for specific referral criteria as these may vary, although some may be enhancements to NICE guidance.

NB: If patient doesn't meet referral criteria for any tumour site, but GP has a gut feeling of malignancy or serious pathology and no other urgent pathway suitable then consider referring to Multi-disciplinary Diagnostic Centre (MDDC) in the tab on the left.

NB: If referring under 2WW please give patient 2WW Urgent Referral leaflet and What Happens Next? Leaflet


For ENHT suspected colorectal cancer referrals:

If a patient presents with symptoms/signs suggestive of lower GI cancer, please look at the ‘Lower GI & FIT process pathway’ in the tab on the left.

This contains the NG12/DG30 clinical decision tool (below) and the referral pathway following this. The Lower GI 2ww form and a presentation about FIT (which provides further details about FIT testing in symptomatic patients) are provided via the blue buttons on the left.  The 2WW form is also available on Ardens.

Important notes:

  • FIT SCREENING AND FIT SYMPTOMATIC TESTING ARE NOT THE SAME. FIT thresholds used in FIT bowel cancer screening are different to FIT thresholds in symptomatic patients.  So patients who have a negative FIT screening result may still have colorectal cancer and should be offered a symptomatic FIT test if appropriate (please see the FIT clinical decision tool on the pathway to determine the appropriateness of FIT testing). Further information on important differences between FIT used for bowel cancer screening and FIT used for symptomatic patients can be found on the Cancer Research UK website (accessedhere:
  • Please refer to the guidance notes on the 2WW form for specific definitions on the symptoms.
  • Please note that there are now Mandatory Investigations that must be provided before sending the 2WW referral.

pathway illustrating the lower GI straight to test process that is in place at ENHT following lower GI 2ww referrals is provided on the tab on the left.

NB: If referring under 2WW please give patient 2WW Urgent Referral Leaflet