Please review changes to the Lower GI Cancer Pathway in relation to FIT testing
South West London Pathology provides the symptomatic FIT testing service for the following boroughs in south London/Surrey:
- Croydon
- Merton
- Sutton
- Wandsworth
- Kingston
- Richmond
- Surrey Dows (Epsom and East Elmbridge localities)
If you are a primary care clinician in one of these boroughs and would like to report an issue or request further information please email: SWLPBusinessDevelopment@stgeorges.nhs.uk.
Ordering FIT testing kits
You can order more FIT testing kits via the South West London Pathology website as you would for other pathology samples.
For Merton and Sutton, FIT testing will need to be requested via DART. Practices will need to order testing kits using the order form called ‘St Helier Phlebotomy Stock Order Form incl FIT’ which can be found on the document section of the website. Completed templates should then be returned to esth.phlebotomy1@nhs.net.
About the Faecal Immunochemical Test (FIT)
The Faecal Immunochemical Test (FIT) is a type of faecal occult blood test which uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect and quantify the amount of human blood in a single stool sample.
An abnormal result suggests that there may be bleeding within the gastrointestinal tract that needs to be investigated. Those with an abnormal result are then invited for further testing via a diagnostic procedure.
FIT is given to patients to carry out at home and return to their GP.
Practices will receive:
- the specially designed test tube
- a green plastic pouch for the test tube with the sample.
Patients must be given:
- a patient information leaflet (available in 12 different languages, see below)
- a request form, which needs to be kept with the sample when it is sent to the lab with sample date written
- the specially designed test tube
- a green plastic pouch for the test tube to be put into once completed
- a pathology sample bag if available to return the sample to the practice
- the Covid-19 2WW Patient Information Leaflet
- the Covid-19 Bowel Information leaflet available.
Who should have the FIT test?
Offer a FIT test before referring to assess for colorectal cancer in adults with abdominal and bowel symptoms. These could include any one or a combination of the following unexplained symptoms:
- abdominal mass
- rectal bleeding (patient should take the sample from a stool when bleeding is not seen)
- change in bowel habit
- iron deficiency and non-iron deficiency anaemia
- abdominal pain
- weight loss
Only refer patients urgently if FIT is ≥10 or they have:
- rectal/anal mass or ulceration
- FIT is ≤10 with clinical concenrs of colectoral cancer (as per NG12 guidance)
These criteria are based on the response to the Covid-19 pandemic and are reflected on the Covid-19 LGI referral form.
Benefits of using FIT
Benefit for patients
- Avoid more invasive tests
- Reduce anxiety as it is most unlikely that the patient has cancer and would not benefit from an early referral for colonoscopy (for those whose FIT test is negative)
- Earlier diagnosis of cancer
Benefit for primary care clinicians
- More patients with bowel cancer can be identified at an early stage
- Offers greater confidence in managing some patients with benign bowel conditions without the need for more invasive tests
- Making FIT available to your patients will offer reassurance to the majority who do not have cancer and ensure use of hospital resources is maximised for those who need care urgently.
Administering the test
1. Patients from Sutton, Merton, Richmond, Kingston, Wandsworth and Surrey Downs (Epsom & East Elmbridge) will have labels provided on the request form. Remove the label and stick it on the test tube. Please ensure the patient checks their details are correct, then they must write the DATE they collected their sample where indicated on the request form.
Patients from Croydon please ensure the patient writes their (N) NAME, (A) DATE OF BIRTH and the (D) DATE they collected their sample on the test tube itself and where indicated on the request form.
2. It is advised that the referring primary care clinician refer to the instructions and explain to the patient how to collect the stool sample without it being contaminated with the water in the toilet bowl.
3. Primary care clinicians must complete the request form on their local system eg Sunquest ICE , DART or TQuest – search ‘Faecal Immunochemical Test’, print and insert request form in the test pack (DART users to return their forms to esth.phlebotomy1@nhs.net).
4. Give the test pack to the patient and advise them to read the instructions carefully before they complete the test and return the pack which will contain the test tube and request form to the practice within three working days.
Interpreting the results
FIT negative/normal: Negative patients have an extremely low risk both of colorectal cancer, and of high-risk adenoma. Your patient does not need a referral for suspected colorectal cancer, but as always you should consider seeking specialist advice if worrying symptoms persist.
FIT positive/abnormal: Refer via 2WW lower GI pathway. The form has been updated in response to the Covid-19 pandemic and is available to download for EMIS/VISION practices.
Patient information leaflets
The patient information leaflet is available in 12 languages.
FIT patient information leaflet – Arabic
FIT patient information leaflet – Bengali
FIT patient information leaflet – Chinese Simplified
FIT patient information leaflet – Chinese Traditional
FIT patient information leaflet – English
FIT patient information leaflet – Gujarati
FIT patient information leaflet – Hindi
FIT patient information leaflet – Polish
FIT patient information leaflet – Punjabi
FIT patient information leaflet – Somali
FIT patient information leaflet – Turkish
FIT patient information leaflet – Urdu
Key documents
Below are links to the key documents for the FIT service.
Covid-19 2WW Lower GI Referral form
Cancer Research UK Safety netting guidance
SWL Covid-19 Lower GI Flowchart
Covid-19 2WW Patient Information Leaflet
Your feedback on FIT
For all primary care staff
As the FIT test is being used to guide referral of patients who have suspected bowel cancer symptoms in Croydon, the team at Croydon Hospital are keen to learn more about your experience of using FIT.
We have created a short online survey for you to feedback, accessible on computer or smartphone. The survey should only take five minutes to complete.
The simple survey covers your day to day use of FIT, how you discuss FIT with patients and reservations you may have using FIT.
Please let us know what you think so we can improve our FIT pathway for urgent colorectal referrals.