1. What to look out for and why?
Abnormal lower GI investigations (colonoscopy/flexible sigmoidoscopy) suggestive of cancer (please give full clinical details in the ‘additional clinical information’ box below)
Any age with suspicious abdominal or rectal mass
Any age with unexplained anal mass or ulceration
≥ 40 years with unexplained abdominal pain and weight loss
≥ 40 years with unexplained iron deficiency anaemia
≤ 50 years with rectal bleeding with any of the following unexplained symptoms:
Abdominal pain
Change in bowel habit
Weight loss
Iron deficiency anaemia (attach results)
≥ 50 years with unexplained rectal bleeding
≥ 50 years with unexplained abdominal pain or weight loss
≥ 50 years with unexplained change in bowel habit
≥ 60 years with unexplained anaemia even in the absence of iron deficiency
Since April 16.
Main changes any anaemia in the elderly, but cut off no longer suggested
Change in bowel habit no longer specifies to looser or more frequent stool

2. Risk factors

3. Screening
BCSP
FOB via post to all pts over 60 years registered with GP until age 74, (opt in for older)
If positive (2%) – colonoscopy
40% have polyps (adenomatous)
10% have cancer
BSS
Flexi sig (one-off) for everyone aged 55
Aim to remove adenomas; pilot showed 40% reduction in distal colorectal cancers at 10 years
49.6% of SE londoners respond to test Eng avge 57.7%
BCSP
•       FOB via post to all pts over 60 years registered with GP until age 74 (opt in for older)
•       If positive (2%)  – colonoscopy
–      40% have polyps (adenomatous)
–      10% have cancer 
•       Flexi sig (one-off) for everyone aged 55. Aim to remove adenomas; pilot showed 40% reduction in distal colorectal cancers at 10 years 

4. Patients with a normal endoscopy in the last 2 years
2ww referrals for?
Patients who have had treatment for bowel cancer and are on their 5 year surveillance program
Patients with a normal endoscopy in the last 2 years