Colorectal cancer

Introduction: the symptomatic patient

From Cancer Guidelines Wiki

Background[edit source]

In Australia approximately 75% of bowel cancers are diagnosed symptomatically, although this may fall with the implementation of biennial screening through the National Bowel Cancer Screening Program (NBCSP).[1] The majority of people with symptomatic colorectal cancer first present to general practice. General practitioners (GPs) are faced with the challenge of identifying patients with symptoms that are due to colorectal cancer amongst the many people with similar symptoms that are caused by benign conditions. A recent study from Victoria, Australia, found that over a third of patients with colorectal cancer had taken more than 3 months from developing symptoms to seeing a hospital specialist.[2] This finding may reflect poor community symptom awareness, later GP referral or limited access to colonoscopy services.

There is significant growth in demand for colonoscopy, with almost 600,000 Medical Benefits Schedule (MBS)-funded colonoscopies performed in Australia in 2013–2014 and significant problems of managing demand in the public hospital system.[3] The majority of these colonoscopies are likely to be for people with symptoms. Guidance is needed, therefore, to inform selection of patients in primary care who warrant referral for investigation of symptoms suggestive of colorectal cancer. Guidance is also needed in endoscopy units to inform triage of patients with symptoms suggestive of colorectal cancer, and determine the appropriateness and urgency for colonoscopy.

References[edit source]

  1. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program: monitoring report 2016. Cancer series no. 98. Cat. no. CAN 97. Canberra: AIHW; 2016.
  2. Lacey K, Bishop JF, Cross HL, Chondros P, Lyratzopoulos G, Emery JD. Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey. Med J Aust 2016 Jul 18;205(2):66-71 Available from:
  3. Australian Commission on Safety and Quality in Health Care. Australian atlas of healthcare variation. [homepage on the internet]; 2016 Available from: