MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon

bowelcancerwest.org.uk

2 Week Criteria ‘everyone with suspected cancer will be able to see a specialist within 2 weeks of their GP deciding that they need to be seen urgently and requesting an appointment’

Where were the delays?

Colorectal cancer 2WW criteria  Rectal bleeding WITH a change in bowel habit to loosened stool and/or increased frequency of defaecation persistent for 6 weeks (all ages)  Change in bowel habit above WITHOUT rectal bleeding and persistent for 6 weeks  Rectal bleeding persistently WITHOUT anal symptoms  A definite right sided abdominal mass  A definite palpable rectal mass (not pelvic)  Iron deficiency anaemia Below 10gms post-menopausal women Below 11gms all men Anal symptoms include soreness, discomfort, itching, lumps and prolapse as well as pain

Aims – 2 Week Standard  80-90% of bowel cancer patients identified by GPs, referred and seen within two weeks  The total number of patients referred kept to a minimum and easily accommodated within existing resources 100% effective high efficiency

Age and Symptom Profiles

Diagnostic Yield

Correct Referral

How to Improve GPs Effectiveness and Efficiency

Proportion of Cancer Patients Identified by Higher Risk Criteria Overall 76 / 83 92% TWC36 / 3895% Non-TWC40 / 4589% Guidelines valid

 Only send patients with:  New symptoms  Persistent symptoms  Need to be aware of the importance of anal symptoms in patients with rectal bleeding Take Home Message

 the referral criteria are effective and reasonably efficient  By appropriate use, most cancers can be diagnosed in the 2WW clinic

Key Points for GP Education  Must identify patients with new symptoms  Importance of only referring patients with symptoms persistent for at least 6 weeks  Importance of the absence of anal symptoms in patients with rectal bleeding

Introduction NAEDI Bowel Awareness Campaign 2011 Department of Health’s National Awareness and Early Diagnosis Initiative (NAEDI)

30% increase in 2WW referrals Colorectal 2WW Referrals Received between 1 st January and 31 st June 2009, 2010 and 2011

35% increase in colonoscopies Colonoscopy's Performed between 1 st January and 31 st June 2009, 2010 and 2011

17% more flexi sigs Flexi-signmoidoscopy`s Performed between 1 st January and 31 st June 2009, 2010 and 2011

8% more Barium enemas Barium Enem as performed between 1 st January and 31 st June 2009, 2010 and 2011

No increase in CT CTs Performed between 1 st January and 31 st June 2009, 2010 and 2011

No increase in cancers diagnosed Colorectal Cancers Diagnosed between 1 st January and 31 st June 2009, 2010 and 2011

2WW PHNT

Take Home Messages  Refer persistent new onset symptoms to 2WW  Family history is useful  We have (relatively) short waiting times for non 2WW  Don’t hesitate to call us!

ANY QUESTIONS?