Are patients referred from primary care as ‘‘Urgent SuspectedColorectal Cancer’’ likely to have colonic malignancy?

Aims:General Practitioners (GPs) are frequently faced with patients presenting with lower gastrointestinal symptoms. Further investigation is initiated by referral to colorectal services in secondary care on either a routine or urgent basis depending on the clinical suspicion of colorectal malignancy. This is aided by standardised referral guidelines. Government targets dictate that,urgent referrals have their investigations expedited compared to those referred routinely. Diagnostic yield of this pathway is unknown and this study aims to determine the likelihood of having malignancy if referred in an urgent manner to our unit.
Methods: A consecutive cohort of 500 patients referred as ‘‘urgent suspected cancer’’ to our service between 1/10/10 and 1/4/11 were included. All those referred from other sources were excluded. Data was collected prospectively on a standardised data set and supplemented with laboratory data and correspondence with the GP. Analysis was made using SPSS v20·0,
Results: Of 500 patients, 224 (45%) were males, with a median age of 67.Patients with symptoms for less than 6 weeks constituted 97 referrals (19·4%).Referrals with only one symptoms occurred in 196 (39·2%) with altered bowel habit being the most common. 493 (98·6%) patients had further investigations.No pathology was identified in 173 (34·6%) which was the most common finding. Diverticulosis occurred in 79 (15·8%) of cases. Colorectal malignancy was found in 37 patients (7·4%).
Conclusions: With increasing numbers of patients being referred to secondary care, investigative services such as colonoscopy and radiology are ever more stretched. These data highlight the low diagnostic yield obtained from clinical suspicion alone when attempting to diagnose colon cancer. Further advances in non invasive investigation may improve diagnostic yield in this cohort