Suspected colorectal cancer — MSRA MCQ

Correct answer: C — Refer now to an appropriate colorectal secondary-care pathway without delaying because the quantitative FIT result is below 10 micrograms haemoglobin per gram of faeces

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

D is correct. This man has several concordant features producing strong clinical concern for colorectal cancer: a palpable abdominal mass, persistent change in bowel habit, unintentional weight loss and confirmed iron-deficiency anaemia. Although FIT is recommended to guide colorectal referral in people with an abdominal mass, change in bowel habit or iron-deficiency anaemia, a result below 10 micrograms haemoglobin per gram does not justify delaying referral where ongoing symptoms or signs create strong concern, specifically including an abdominal mass. His previous negative screening FIT does not alter this: symptomatic FIT should still be offered after a negative screening result, because screening and symptomatic testing serve different clinical contexts. A is wrong because repeating a low FIT delays assessment despite the mass and systemic features. B is inappropriate because iron replacement may be started but must not defer investigation of unexplained iron-deficiency anaemia with a mass. C is initially plausible because the FIT is below the usual threshold for suspected cancer referral, but routine referral is insufficient in this high-concern presentation. E incorrectly treats FIT as a rule-out test and ignores both the examination finding and the difference between screening and symptomatic FIT.

Reference: NICE NG12: Suspected cancer: recognition and referral — Lower gastrointestinal tract cancers, recommendations 1.3.1–1.3.3 (2015; amended 2023) — https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer