Introduction
Two-week suspected cancer referral (TWR) pathway is a colorectal cancer exclusion service and One of the symptoms for referral is fresh bleeding which are left sided colonic pathologies and mostly benign. We wanted to find out whether flexible sigmoidoscopy is enough in the presence of rectal bleeding to rule out cancer in FIT-positive patients and are we doing too much FIT testing and colonoscopies when not required.
Methods
Retrospective data collection from all patients referred as TWR from June 2020 - Nov 2021 (Covid period) and January - July 2024 (Post-Covid) n= 2693. Inclusion criteria: All patients having fresh bleeding PR as the complaint, excluding patients having Iron deficiency anaemia, n= 442 (16%) at Wigan, Wrightington and Leigh hospital.
Results
1. Overall combined 6.56% Colorectal cancers diagnosed with fresh PR bleeding
2. 1% had right-sided cancers diagnosed with fresh bleeding PR
3. All the right-sided cancers had either Change in bowel habit +/- weight loss
4. Majority (~76%) of patients underwent Colonoscopy
Conclusions
1. We are over-investigating with colonoscopy resulting in a significant bump in the waiting times.
2. Patients with constitutional symptoms would have a CT scan regardless and therefore only flexible sigmoidoscopy should be enough.
3. If a suspicious lesion is seen during flexible sigmoidoscopy, we can either complete a full scope or opt for CTC +CT Thorax for (staging).
4. Repeat FIT test before proceeding with a TWR – may be given a consideration without cancer red flags
5. GP should exclude anorectal aetiology before considering FIT testing
Authors
SHREYA SENGUPTA
Manchester, Manchester, United Kingdom
Violet Alavi
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom