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Colorectal cancer: The role of primary Care

Role of GPs in colorectal cancer

GPs play a vital role in the overall management of colorectal cancer. Patients often know and trust their GP. The GP may be instrumental in picking up suspicious symptoms early enough to refer them to secondary care. GPs have difficult job in doing this in the limited time they have with patients, considering that the vast majority of patients who visit them do not have cancer. The task is somewhat helped by implementation of the referral guidelines (see below), but many experience GPs have to make a judgment when they see one of their long term patients loose weight or energy for no good reasons - among many other situations - while all the time making sure they do not overburden secondary care, which would inevitably stretch the resources for investigating all patients.

GPs often have to trace results, counsel patients and their families about the diagnosis, give advice about screening and genetic testing, remove clips or sutures & check wounds following operations as well as partly look after terminally ill patients in the community.

Luckily for GPs, there is increasing help and co-operation from hospitals' colorectal multidisciplinary teams, clinical nurse specialists, Macmillan nurses, Stoma care nurses, palliative care teams and pain care teams. GPs role may be summarized as:

1. Early diagnosis

2. Screening patients with genetic predisposition (see colorectal cancer screening & colorectal cancer genetics web pages)

3. Advice regarding choice of treatment / choice of surgeon (see colorectal cancer: does the surgeon matter?)

4, Advice about access to social care, benefits etc

4. Support of patient, spouse and their family

6. Symptomatic / palliative care at community level


Current NHS guidelines for urgent referrals (2 weeks) of patients with suspected colorectal cancer


Guidelines for urgent (2 w) referral in patients with suspected CRC
All ages

Definite palpable right sided abdominal mass

Definite palpable rectal mass

Rectal bleeding with change in bowel habits (more frequent defaecation or looser stools) persistent for > 6 weeks

Iron deficiency anaemia without an obvious cause (Haemoglobin concentration <11 g/dl in men or < 10 g/dl in postmenopausal women)
> 60 years
Rectal bleeding without anal symptoms (soreness, discomfort, pain, itching, prolapse)
Change in bowel habits (more frequent defaecation or looser stools) without rectal bleeding persistent for > 6 weeks


Should GPs use the 2 week referral proforma? & why?

Yes. It provides the catalyst for enforcing a 2 week rule in instigating various investigations

What about an accompanying referral letter?

Vital as well especially in patients with complex medical history or if there is special psychological or social factors that may influence management (e.g. caring for an ill spouse or child, depression, being homeless, children living abroad etc.)

So why not just an ordinary referral letter?

Because it may tie the hands of hospital consultants when demanding that certain investigations be done within a particular time frame

When should GPs refer outside the guidelines?

Use your judgment. Even specialists and experts get it wrong from time to time. Just be conscious of overburdening hospital resources and the potential impact on other patients.













Deya Marzouk, Consultant Surgeonscalpel pix