Referral to a specialist for bowel cancer

Your GP should arrange for you to see a specialist or have tests if you have symptoms that could be due to bowel (colorectal) cancer. 

Depending on your symptoms and other factors, this might be an urgent suspected cancer referral.

You will see a specialist or have tests as soon as possible. Ask your GP when this is likely to be.

Seeing your GP

It can be hard for GPs to decide who may have cancer and who might have a more minor condition. For some symptoms, your doctor may ask you to wait to see if the symptoms get better or respond to any treatment they have given you.

Your GP might arrange for you to have some tests first. They might include:

• a faecal immunochemical test (FIT) which looks for traces of blood in your poo - your GP or your local hospital might organise this test for you

• blood tests

• a CT scan

The results will help them decide if you need to see a specialist.

Symptoms of bowel cancer

Symptoms of bowel cancer can include:

• bleeding from the back passage (rectum) or blood in your poo

• a change in your normal bowel habit, such as looser poo, pooing more often or constipation

• a lump that your doctor can feel in your rectum (back passage) or tummy (abdomen)

• a lump or ulcer that your doctor can feel on your back passage opening (anus)

• a feeling of needing to strain in your back passage (as if you need to poo), even after opening your bowels

• losing weight when you haven’t been trying to

• pain in your abdomen or back passage

• tiredness and breathlessness caused by a lower than normal level of red blood cells (anaemia)

When you see your GP, you’re likely to have an examination of your rectum (back passage) and your tummy (abdomen).

UK referral guidelines

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) together with the British Society of Gastroenterology (BSG) have guidelines to help GPs decide who needs to see a specialist. As each nation’s guidance is slightly different, these guidelines give an overview for GPs.

What do the joint guidelines say?

You should have a test to check for hidden blood in your poo if you have symptoms that could be caused by bowel cancer. This is called a faecal immunochemical test (FIT).

Some people need to have an urgent cancer referral straightaway. This includes people with:

• a lump or swelling in their back passage (rectum)
• a lump or swelling in their back passage opening (anus)
• an unexplained ulcer on their back passage opening (anus)

This means that you don’t do a FIT test first.

The FIT results helps your doctor decide if you need an urgent cancer referral. Most people with a normal FIT result can be reassured about their bowel symptoms. If your symptoms don’t go away contact your GP surgery again. This is even if you have had a normal FIT result. Contact your GP surgery if you notice anything else that is unusual for you.

Some people with a normal FIT result have other symptoms meaning they need an urgent cancer referral or more tests.

You may also have other tests before, or at the same time, as an urgent cancer referral. These can be different depending on where in the UK you live. You might have:

• blood tests

• a CT scan

Second FIT test

Depending on where you live, you might be asked by your GP to do a second FIT test if your symptoms don’t go away. This can help them decide if you need to see a specialist.

What happens if you can’t do a FIT test?

Not everyone is able to do a FIT test at home. Let your GP know if you think this will be a problem for you. They might be able to give you support to complete the test. Or look at other ways of investigating your symptoms.

Other symptoms

Your GP will consider any other symptoms you have, so do mention these.

Risk factors

Your GP might also take into account whether you have any risk factors that affect your chances of developing bowel cancer.

If you're still worried

Sometimes you might feel that your GP is not concerned enough about your symptoms. If you think they should be more concerned, print this page and the symptoms page. Ask your GP to explain why they don’t think you need a referral.

Contact your GP again if your symptoms don't get better or you notice any new or unusual symptoms. 

What should you do if you don’t get an appointment?

If your GP has referred you to a specialist, ask them when you should get your appointment. Contact them again if you don’t get one. Or some hospitals have a referral service you could try contacting if you know which hospital you are going to. Explain that you are waiting for an urgent suspected cancer referral.

Waiting times

Your hospital is working towards waiting time targets. For example, a target to find out whether you have cancer or not. And there are targets to start treatment if you are diagnosed with cancer. These are slightly different depending on where you live in the UK.