What criteria should I use to refer a patient for suspected colorectal cancer based on their symptoms?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Criteria for referral for suspected colorectal cancer based on symptoms:

  • Offer quantitative faecal immunochemical testing (FIT) to patients aged 50 and over with unexplained rectal bleeding.
  • Offer FIT to adults under 50 with rectal bleeding accompanied by unexplained abdominal pain or weight loss.
  • Offer FIT to patients aged 40 and over with unexplained abdominal pain and weight loss.
  • Offer FIT to patients aged 50 and over with unexplained abdominal pain.
  • Refer patients with a rectal mass found on examination using a suspected cancer pathway referral.
  • Consider referral if there is an anal mass or anal ulceration unexplained by other causes.

These criteria are adapted from NICE's diagnostics guidance on quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care and the NG12 guideline on suspected cancer recognition and referral .

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Educational content only. Always verify information and use clinical judgement.