1. Barts Health Trust 2WW Colorectal Workshop Dr Angela Wong,
Clinical Director Cancer
Consultant Gastroenterologist
September 2015

2. CONTENTS
1. 2Overall Context
1. Cancer Plan 2000
2.Cancer Reform Strategy 2007
3. Improving Outcomes
2. Background
1. introduction
2. Routes to Diagnosis and Survival
3. Bartshealth 2WW
4. NICE guidance
5. Cases
6. STT
8. Conclusion
9. Questions?

3. 1 1
Overall Context

5. Also 62 upgrade
31 DTT

7. Background Colorectal1 2
Background Colorectal

8. Introduction 4 Colorectal
40,000 new colorectal cancers are diagnosed each year in the UK, up to a quarter of these following screening.
A full time GP is likely to diagnose approximately 1 person with colorectal cancer every year.
Five year survival is approximately 60%, though this figure includes cancers detected by screening as well as those identified after symptoms have occurred.
Symptoms
Most common being diarrhoea, constipation (sometimes referred to as ‘change of bowel habit’) rectal bleeding, loss of weight, and abdominal pain.
Colorectal cancer may present with anaemia, particularly iron deficiency anaemia.

9. Routes for diagnosis for diagnosis
27% 2WW scheme (red flag signs)
48% GP/other OP/ routes of referral
25% AE presentation (late with poorer outcomes)

10. Colorectal Cancer Routes to diagnosis5
Colorectal Cancer Routes to diagnosis
Colorectal 5% 27% 25% 9% 5% 25% 0% 4%

11. Colorectal Cancer 1YS

13. 1 3
Bartshealth trends

14. Bartshealth 2WW referral trends 2010-15

15. Conversion BH colorectal 2WW to cancer

16. Whipps Cross 2WW referral trends

17. Conversion 2WW colorectal referrals to cancer

18. NICE referral guidance1 4
NICE referral guidance

19. NICE guidance June 2015
Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
 they are aged 40 and over with unexplained weight loss and abdominal pain or
 they are aged 50 and over with unexplained rectal bleeding or
 they are aged 60 and over with:
iron–deficiency anaemia or
changes in their bowel habit, or
 tests show occult blood in their faeces [new 2015]

20. Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in people with a rectal or abdominal mass. [new 2015]
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
٠abdominal pain ٠change in bowel habit
٠weight loss
٠iron-deficiency anaemia. [new 2015]

21. FOB Offer testing for occult blood in faeces to assess for
colorectal cancer in adults without rectal bleeding who:
are aged 50 and over with unexplained:
٠ abdominal pain or
٠weight loss, or
٠ are aged under 60 with
٠changes in their bowel habit or
٠iron-deficiency anaemia or
٠are aged 60 and over and have anaemia even in the
absence of iron deficiency. [new 2015]

22. 1 5
Cases

23. Case 1
22 year old
Loose stool
Rectal bleeding on and off for 1 year

24. Case 2 60 male Overt rectal bleeding GP x1, AE x 2 told haemorrhoids
Admitted symptomatic anaemia

25. Case 3
65 yo male
Carer
Admitted weakness
Found to have abnormal LFTs

26. 1 6
STT

27. Traditional Pathway GP referral Consultant triage Out-patients 8 weeks
Lower GI investigation
Out-patients
6 weeks
3 months

28. STT model GP referral Nurse telephone assessment 3 days
Lower GI investigation
? Out-patient review
2-4 weeks

30. 1 7
What next 2020?

31. 2020
NHS patients in England should get results for cancer tests within four weeks of being referred by a GP by 2020 under new plans to improve treatment.
NHS England's cancer taskforce is also replacing old radiotherapy machines and increasing specialist staff to ensure it delivers "world class" cancer care.
The five-year plan will cost £400m a year but experts say earlier treatment will result in similar savings.
They say the plan could help an extra 30,000 patients survive for 10 years.

33. 1 8
Conclusion

34. Conclusion Refer according to guidelines Follow clinical intuition
Complete form
Explain referred on a cancer pathway
Discuss with people with suspected cancer (and their
carers as appropriate, taking account of the need for
confidentiality) their preferences for being involved in
decision-making about referral options and further
investigations including their potential risks and benefits.
[2015]
Explain to people who are being referred with suspected
cancer that they are being referred to a cancer service.
Reassure them, as appropriate, that most people referred
will not have a diagnosis of cancer, and discuss alternative
diagnoses with them. [2015]
Give the person information on the possible diagnosis
(both benign and malignant) in accordance with their
wishes for information (see also the NICE guideline on
patient experience in adult NHS services). [2015]
The information given to people with suspected cancer and
Suspected cancer
Patient information and support their families and/or carers should cover, among other
issues:
 where the person is being referred to
 how long they will have to wait for the appointment
 how to obtain further information about the type of cancer
suspected or help before the specialist appointment
 what to expect from the service the person will be
attending
 what type of tests may be carried out, and what will
happen during diagnostic procedures
 how long it will take to get a diagnosis or test results
 whether they can take someone with them to the
appointment
 who to contact if they do not receive confirmation of an
 other sources of support. [new 2015]
Provide information that is appropriate for the person in
terms of language, ability and culture, recognising the
potential for different cultural meanings associated with the
possibility of cancer. [new 2015]
Have information available in a variety of formats on both
local and national sources of information and support for
people who are being referred with suspected cancer. For
more information on information sharing, see section 1.5 in
the NICE guideline on patient experience in adult NHS
services. [new 2015]
Reassure people in the safety netting group (see
recommendation in chapter 5) who are concerned that they
may have cancer that with their current symptoms their risk
of having cancer is low. [new 2015]
Explain to people who are being offered

35. 1 9
Questions?