STEP 2: Presentation, initial investigations and referral

The following signs, symptoms and results should be investigated:

  • positive iFOBT
  • passage of blood with or without mucus in faeces
  • unexplained iron deficiency anaemia
  • change in bowel habit (loose stools or constipation), especially a recent one
  • undiagnosed abdominal pain or tenderness
  • unexplained rectal or abdominal mass
  • unexplained weight loss
  • lethargy

Initial investigations include:

  • detailed family history for patients presenting with possible symptoms of colorectal cancer
  • physical examination
  • digital rectal examination
  • full blood examination and iron studies

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments informing the patient and/ or carer that they can contact Cancer Council on 13 11 20.



Test results should be provided to the patient within 1 week of testing.

If symptoms suggest colorectal cancer, patients should be referred and colonoscopy completed within 4 weeks.

Patients should see a surgeon within 2 weeks of GP referral following a positive diagnosis of colorectal cancer via colonoscopy.