Practices are reminded that Faecal Immunochemical Test (qFIT/FIT) samples for symptomatic patients should be clearly labelled and sent to local laboratories. Any symptomatic samples sent to the Bowel Screening Hub will not be processed. Please see downloads for the differences between FIT for symptomatic patients and FIT for screening.
From 1 April 2019, the FIT test for suspected colorectal cancer has been available to NCL GP Practices.
Offer a FIT test before referring to assess for colorectal cancer in adults in both low-risk (DG30) and high-risk (NG12) cases with lower GI symptoms who meet the following criteria below. Those patients who have iron deficiency anaemia, rectal or anal mass, or anal ulceration should be referred straight onto the Lower GI (LGI) 2ww for suspected colorectal cancer (CRC) pathway.
Low risk (DG30) symptomatic
DG 30 criteria in adults without rectal bleeding:
- ≥ 50 years with unexplained abdominal pain or weight loss
- <60 years with changes in bowel habit
- <60 years with iron-deficiency anaemia
- ≥ 60 years with anaemia, but without iron deficiency
NICE NG12 urgent referral criteria
- ≥ 40 years with unexplained abdominal pain AND weight loss
- >50 with unexplained rectal bleeding
- > 60 with iron deficiency anaemia OR change in bowel habit
- < 50 with rectal bleeding AND any one of following abdominal pain, change in bowel habit, weight loss or iron deficiency anaemia
See Downloads for the NCL LGI pathway FAQ for GPs document.
- Ask the patient to take the sample as per the instructions on the patients leaflet (see Downloads) It is essential for the sample to be taken as soon as the faeces is produced as it deteriorates quickly. Sample must also be sent with correctly completed tQUEST / SunQuest ICE form to avoid delays in getting back results.
- Refer to the FIT for patients presenting with bowel symptoms video (See Related Video) and the FAQs (see Downloads) for information about the FIT test in NCL.
- The test can be found in EMIS pathology tests under FIT (Faecal Immunochemical Test).
- FIT for symptomatic patients is the same test as the FIT used in the National Bowel Cancer Programme. However the cut off level for positivity is much higher in the screening programme (120µg/g faeces vs. 10µg/g faeces). It is therefore important to request a FIT for a symptomatic patient even if he recently returned a bowel cancer screening FIT.
FIT <10 NG12 follow-up clinic on Lower GI pathway
From 30 April 2021 a separate, non-2WW, referral pathway to the existing LGI urgent cancer pathway was introduced as part of a 1 year service evaluation programme. Instead of safety netting this cohort of patients in primary care, GPs should now refer patients with the following referral criteria to secondary care via ERS on the FIT <10 safety netting pathway:
- Symptoms meeting NG12 criteria for suspected CRC
- FIT concentration <10 µg/g
- Absence of any of the following: iron deficiency anaemia, rectal mass, anal ulceration
The NCL protocol for this pathway is as follows:
- referral received via ERS on ‘FIT <10 NG12 follow-up pathway’
- referral checked for completeness and missing information sought from GP
- patient wil be booked by the hospital for repeat bloods (FBC), FIT and a virtual follow-up clinic in 8-10 weeks
- consultant led virtual/ telephone clinics to determine management plan
- options are D/C to GP, consultant upgrade onto urgent cancer pathway, further investigations on RTT pathway
This cohort of patients will be tracked based on referral source on a specific tracking list in order to differentiate them from the Two Week Wait (2WW) and referral to treatment (RTT) patient tracking list (PTL). This differentiation means that the safety netted patients will not distort 2WW performance reporting and will be easy to identify.
See Downloads for FAQs with more information.
- patients must not have an iron deficiency anaemia, a rectal or anal mass, or anal ulceration
How to refer
The following clinicians can refer to this service:
Referral methods: EMIS managed referral
Following FIT test results, if there is need to refer, please complete the correct referral form:
- 2WW - Lower GI Suspected Cancer
- FIT<10 NG12 follow-up pathway (v6)
Where to find the forms
In local EMIS global document library systems.
- Barnet: BAR Global Documents > 2WW Cancer Referral Forms (BAR GLOBAL)
- Enfield: ENF Global Documents > 2ww Cancer Referral Forms
- Haringey: HAR Global Documents > 2WW Cancer Referral Forms
- Islington: ISL Global Documents > 2WW Cancer Referral Forms
Camden: Find the form on the Camden EMIS Forms page under 'Cancer'.