What criteria should be used to determine the need for urgent referral

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

Criteria for urgent referral to a specialist for a patient presenting with rectal bleeding include:

Age 50 and over with unexplained rectal bleeding: offer quantitative faecal immunochemical testing (FIT) to assess colorectal cancer risk and consider urgent referral if indicated .
Adults under 50 with rectal bleeding accompanied by unexplained abdominal pain or weight loss: offer quantitative FIT and consider urgent referral based on results .
Presence of a rectal mass on examination: consider urgent referral via a suspected cancer pathway .
Unexplained anal mass or anal ulceration: consider urgent referral via a suspected cancer pathway .

These criteria aim to identify patients at higher risk of colorectal or anal cancer who require prompt specialist assessment .

What criteria should be used to determine the need for urgent referral to a specialist for a patient with rectal bleeding?