Colorectal cancer

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    • Symptoms of airway obstruction, SVC obstruction
    • Severe gastrointestinal (GI) bleeding
    • Bowel obstruction
    • Febrile neutropenia
    • Symptomatic hypercalcaemia
    • Other organ failure/dysfunction
    • Uncontrolled and disabling pain
    • Massive haemoptysis and/or stridor
    • Neurological signs suggestive of brain metastases or cord compression
    • Very high calcium (3.0mmol/L)
    • Severe dysphagia with dehydration
    • Biopsy proven small cell lung cancer
      • patients with symptoms of shortness of breath, deteriorating organ function
    • Metastatic germ cell tumour (GCT) confirmed (biopsy) or suspected (tumour markers)
    • Patients with severe symptoms, organ failure or life threatening complications
    • Highly aggressive lymphoma
      • Burkitt's lymphoma
      • lymphoblastic lymphoma
    • Acute leukaemia
    • Most patients with radiological evidence of metastatic cancer need biopsy confirmation. These patients need to be seen by a colorectal surgeon.
    • Some patients with liver metastases can undergo curative liver resection
    • The majority of stage II and stage III rectal cancer benefit from pre-operative chemotherapy and radiation
    • Suspected colorectal cancer due to symptoms or iron deficiency anaemia needs to be referred through local gastroenterology or surgical pathways
    • For patients with incurable (metastatic or recurrent) cancer, consideration of the following:
      • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the patient's prognosis and their understanding of their prognosis
      • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
      • specific patient goals and values that may impact on treatment choices
      • whether the patient has been referred to a palliative or supportive care service
    • Optimal care pathway for people with colorectal cancer
    • Quick reference guide
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Metastatic colon cancer with rapid progress or organ dysfunction. For optimum care, patient should be seen within 2 weeks.
  • Neoadjuvant chemotherapy with radiation prior to surgery (usually referred by Surgeon after MDT). For optimum care, patient should be seen within 2 weeks.
  • Adjuvant treatment after surgery (usually referred after MDT by surgeon)
  • Metastatic colon cancer (De novo or following treatment for early-stage cancer) and has tissue confirmation
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • General referral information
  • Family history
  • Previous cancer treatment details
  • FBC ELFTs CEA results
  • Tumour histology report

3. Additional referral information Useful for processing the referral

  • Any relevant XR results and/or relevant CT results
  • MRI of pelvis and endorectal US for rectal cancer for selected patients
  • PET scan results for selected patients
  • Colonoscopy results (if applicable)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 25 May 2017

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