Colorectal or small bowel cancer (A/P-AFF)
Individual from a family in whom a mutation in a cancer predisposition gene has NOT been identified (Adult and Paediatric Conditions in AFFECTED Patients)
Emergency referrals
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- No referrals to emergency relating to genetic testing or review
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- Colorectal or small bowel cancer fulfilling Category 3 criteria with at least one of the following:
- metastatic disease
- the nature or extent of surgery will be determined by the results of genetic testing (if offered)
Category 2
Appointment within 90 days is desirable
- Small bowel cancer fulfilling the Category 3 criteria for colorectal cancer
- Colorectal cancer with at least one of the following:
- diagnosed at age < 40 years
- Stage IV disease (and fulfil criteria for Category 3)
- A patient who fulfils Category 3 criteria and has a limited life expectancy due to advanced age and/or co-morbidities
- features suggestive of Familial Adenomatous Polyposis (FAP):
- ten or more (cumulative) adenomatous colorectal polyps by age 30 years
- twenty or more (cumulative) adenomatous colorectal polyps at any age
- personal history of intra-abdominal or abdominal wall desmoid tumour
Category 3
Appointment within 365 days is desirable
- Colorectal cancer with at least one of the following:
- tumour testing detected abnormal MMR immunohistochemistry or microsatellite instability (MSI) (Link to GHQ website) (except where there is loss of expression of MLH1 and PMS2, and either hypermethylation of the MLH1 promoter or the BRAF V600E mutation is detected in the tumour)
- personal history of a second Lynch syndrome associated tumour or cancer (Link to GHQ website)
- family history of one or more first or second-degree relatives with a Lynch syndrome-associated tumour or cancer, regardless of the age the cancers were diagnosed
- ten or more (cumulative) adenomatous colorectal polyps at any age
- reported family history of polyposis syndrome
- the patient fulfils or is close to fulfilling the diagnostic criteria for serrated polyposis syndrome (SPS)
- one or more hamartomatous polyps at any age (includes Peutz-Jeughers polyps, juvenile polyps, Cowden polyps)
- other personal or family history suggestive of:
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Other important information for referring practitioners
Not an exhaustive list
- The offer of an appointment by GHQ does NOT guarantee that the patient will be offered a publicly funded gene test.
- If the patient is an UNTESTED blood relative of a person with an identified mutation in a cancer predisposition gene please refer to the Untested blood relative condition within the Genetics CPC
- If the patient has undergone mainstreamed and/or private genetic testing refer to the Mainstreamed or private testing condition within the Genetics CPC
- Eligibility for publicly funded genetic testing will be determined using eviQ criteria (See criteria Lynch syndrome, APC, MUTYH, STK11).
- Patients will be asked to provide detailed family information either during a telephone consultation (if urgent) or via a family history questionnaire (Cat 3). One or more Consent to Release information forms may be provided to forward to family members to obtain their consent to confirm details of the reported family history.
- BRAF tumour testing should be arranged prior to referral for patients with loss of MLH1 and PMS2 staining on mismatch repair immunohistochemistry. Molecular BRAF testing is offered by the Molecular Genetics Laboratory, Pathology Queensland.
- If the patient fulfils eviQ criteria for genetic testing and has a very limited life expectancy, arrange for two separate blood collections of 2x4mL EDTA tubes each to be sent to the Molecular Genetics Laboratory, Pathology Queensland (RBWH) for “DNA extraction and storage” prior to or at the time of referral. Advise Pathology Queensland that these specimens have been collected in accordance with Genetics Health Queensland protocols.
Referral requirements
A referral may be rejected without the following information.
Send referral
Hotline: 1300 364 938
Fax: 1300 364 952
Electronic: eReferral system
Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways
Login to Brisbane North Health Pathways:
brisbanenorth.
Resources
Clinical resources
- Named Referral Information Sheet
- Outpatient clinic information
- General referral criteria
- eReferral template