Lower GI Cancer Pathway and FIT: response to Covid-19 pandemic
As of 2 April 2020, there are important changes to the referral and management of lower GI suspected cancers, agreed by NHS England and NHS Improvement London Region with immediate effect until further notice. This is as a result of the Covid-19 pandemic.
Key messages for Primary Care – South West London and London-facing practices
All patients with a suspicion of LGI cancer (except those with an anal or rectal mass) now require a FIT test to be dispensed and results received by Primary Care before a decision to refer is made, ie only refer patients under the 2WW LGI pathway if they have either:
- an anal or rectal mass
- a FIT positive result of >10
For FIT negative (<10) patients who have predominantly bowel symptoms, GPs can:
- consider symptomatic management for four weeks with safety netting to review if not improving
- ask for advice and guidance – if at any point, symptoms significantly deteriorate or there are additional clinical concerns
- refer into secondary care via 2WW Lower GI pathway – if at any point, symptoms significantly deteriorate or there are additional clinical concerns; this will allow secondary care to triage the referral appropriately.
For FIT negative (<10) patients with non-bowel concerns (notably weight loss, abdominal mass, pain and anaemia)
- Please consider other pathology and possible cancer diagnoses and refer to the appropriate 2WW pathway, eg gynaecology, upper GI, urology etc.
These changes are aimed at reducing the number of patients who may unnecessarily visit hospital during the Covid-19 pandemic and who may experience delays as a result of reduced diagnostic capacity. The changes are in place as a response to Covid-19 in London and the arrangements are under continual review as the pandemic progresses.