ABC of colorectal cancer: The role of primary care

Early diagnosis and referral guidelines

Early diagnosis of colorectal cancer is essential in view of the stage related prognosis. Three potential levels of delay occur in the diagnosis of the disease: delay by the patient in presenting to the general practitioner; delay in referral by the general practitioner to a specialist; and delay by the hospital in either establishing the diagnosis or starting treatment. Detrimental differences between England and Wales and the rest of western Europe in survival rates for colorectal cancer arise primarily in the first six months after diagnosis, suggesting that these differences relate to late presentations or delays in treatment.

Patients presenting with symptoms

Most patients developing colorectal cancer will eventually present with symptoms. Primary symptoms include rectal bleeding persistently without anal symptoms and change in bowel habit - most commonly, increased frequency or looser stools (or both) - persistently over six weeks. Secondary effects include severe iron deficiency anaemia and clear signs of intestinal obstruction. Clinical examination may show a definite right sided abdominal mass or definite rectal mass.

Unfortunately, many large bowel symptoms are common and non-specific and often …