What are the key symptoms and signs that should prompt a referral for

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

Key symptoms and signs that should prompt a referral for suspected rectal cancer include:

Unexplained rectal bleeding in people aged 50 and over, for which quantitative faecal immunochemical testing (FIT) should be offered initially.
Rectal bleeding accompanied by unexplained abdominal pain or weight loss in adults under 50, also warranting quantitative FIT.
Detection of a rectal mass on digital rectal examination, which should prompt a suspected cancer pathway referral.
Unexplained anal mass or anal ulceration, which should also lead to consideration of a suspected cancer pathway referral.

These features are considered red flags for colorectal cancer and require urgent investigation or referral according to NICE NG12 guidelines.

What are the key symptoms and signs that should prompt a referral for suspected rectal cancer?