1. MARK COLEMAN MBChB FRCS (Gen Surg) MD hon FRCPSG Consultant Colorectal Surgeon www.bowelcancerwest.org.uk

2. bowelcancerwest.org.uk

3. www.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’

4. www.bowelcancerwest.org.uk Where were the delays?

5. www.bowelcancerwest.org.uk 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

6. www.bowelcancerwest.org.uk 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

7. www.bowelcancerwest.org.uk Age and Symptom Profiles

8. www.bowelcancerwest.org.uk Diagnostic Yield

9. www.bowelcancerwest.org.uk Correct Referral

10. www.bowelcancerwest.org.uk How to Improve GPs Effectiveness and Efficiency

11. www.bowelcancerwest.org.uk Proportion of Cancer Patients Identified by Higher Risk Criteria Overall 76 / 83 92% TWC36 / 3895% Non-TWC40 / 4589% Guidelines valid

12. www.bowelcancerwest.org.uk  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

13. www.bowelcancerwest.org.uk  the referral criteria are effective and reasonably efficient  By appropriate use, most cancers can be diagnosed in the 2WW clinic

14. www.bowelcancerwest.org.uk 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

15. www.bowelcancerwest.org.uk Introduction NAEDI Bowel Awareness Campaign 2011 Department of Health’s National Awareness and Early Diagnosis Initiative (NAEDI)

16. www.bowelcancerwest.org.uk 30% increase in 2WW referrals Colorectal 2WW Referrals Received between 1 st January and 31 st June 2009, 2010 and 2011

17. www.bowelcancerwest.org.uk 35% increase in colonoscopies Colonoscopy's Performed between 1 st January and 31 st June 2009, 2010 and 2011

18. www.bowelcancerwest.org.uk 17% more flexi sigs Flexi-signmoidoscopy`s Performed between 1 st January and 31 st June 2009, 2010 and 2011

19. www.bowelcancerwest.org.uk 8% more Barium enemas Barium Enem as performed between 1 st January and 31 st June 2009, 2010 and 2011

20. www.bowelcancerwest.org.uk No increase in CT CTs Performed between 1 st January and 31 st June 2009, 2010 and 2011

21. www.bowelcancerwest.org.uk No increase in cancers diagnosed Colorectal Cancers Diagnosed between 1 st January and 31 st June 2009, 2010 and 2011

22. www.bowelcancerwest.org.uk 2WW 2011-12 PHNT

23. www.bowelcancerwest.org.uk 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!

24. www.bowelcancerwest.org.uk ANY QUESTIONS?