Colorectal Cancer: Referral Guidelines

A 62-year-old man presents with insomnia and lethargy. He has no other systemic symptoms of note. Routine clinical examination reveals a palpable mass in the right lower quadrant of the abdomen, which doesn't move with respiration and is non-pulsatile.
What is the most appropriate management?

A. Blood screen including LFTs, U&Es
B. Urgent referral to local urological service
C. Ultrasound abdomen
D. Urgent referral to local colorectal service
E. Routine referral to general surgical clinic.

Answer:
D. Urgent referral to local colorectal service

Discussion:
NICE recommend the following patients are referred urgently (i.e. within 2 weeks) to colorectal services for investigation:
 patients > 40 years old, reporting rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for 6 weeks or more
 patients > 60 years old, with rectal bleeding persisting for 6 weeks or more without a change in bowel habit and without anal symptoms
 patients > 60 years old, with a change in bowel habit to looser stools and/or more frequent stools persisting for 6 weeks or more without rectal bleeding
 any patient presenting with a right lower abdominal mass consistent with involvement of the large bowel
 any patient with a palpable rectal mass
 unexplained iron deficiency anemia in men or non-menstruating women (Hb < 11 g/dl in men, < 10 g/dl in women)