In the UK, bowel cancer is the fourth most common with around 42 300 new cases every year. Disappointingly, more than half of bowel cancer cases in England are still being diagnosed at a late stage [1].Most cancer patients will present to their primary care physicians with symptoms although some present as an emergency to the Accident and Emergency Department [2]. Many of the symptoms of early cancer are non-specific and referrals based on vague symptoms alone, for example a change in bowel habit (CIBH), yield a very low cancer detection rate (often <3%) with a high associated cost to the National Health Service (NHS) and a potentially unnecessary risk of investigation to the patient. Regrettably, whilst the number of people referred via the 2-week wait (2WW) pathway in England

Background: This article investigated the impact of COVID-19 on the two-week wait referral pathway at the University Hospitals of Leicester NHS Trust. The conversion rate of these referrals was also explored as an indicator of the appropriateness of referrals from primary care. Methods: Two-week wait referrals to the Cancer Centre of the University Hospitals of Leicester NHS Trust from 2018 to 2020 were collected for upper gastrointestinal (UGI), lower gastrointestinal (LGI), and hepatopancreato-biliary (HPB) surgery. The confirmed cancer cases out of these referrals were also recorded. Additionally, the outcomes of the multidisciplinary team (MDT) meetings for all patients discussed in June 2018, 2019, and 2020 were collected, and their staging and treatment data were examined.Results: The number of two-week referrals decreased in 2020 compared to the previous two years across the three specialities. This was more pronounced in April, with a reduction of over 50%. The conversion rate of these referrals increased in 2020 compared to 2018 and 2019 among all three specialities. The increase in conversion rate was statistically significant for LGI referrals (2018 vs 2020 p = 0.0056; 2019 vs 2020 p = 0.0005). There was no significant difference in the MDT outcome across the three specialities.Conclusion: Two-week wait remains a cornerstone pathway in the management of patients with suspected cancer in the National Health Service. The COVID-19 pandemic appeared to have reduced inappropriate referrals, as evidenced by the increased conversion rate. This did not appear to negatively impact tumour staging and outcomes for those patients who were referred on the pathway.

(1) Background: The service capacity for colonoscopy remains constrained, and while efforts are being made to recover elective services, polyp surveillance remains a challenge. (2) Methods: This is a multi-centre study recruiting patients already on polyp surveillance. Stool and urine samples were collected for the faecal immunochemical test (FIT) and volatile organic compounds (VOC) analysis, and all participants then underwent surveillance colonoscopy. (3) Results: The sensitivity and specificity of VOC for the detection of a high-risk finding ((≥2 premalignant polyps including ≥1 advanced polyp or ≥5 premalignant polyps) were 0.94 (95% CI, 0.88 to 0.98) and 0.69 (95% CI, 0.64 to 0.75) respectively. For FIT, the sensitivity was (≥10 µg of haemoglobin (Hb) / g faeces) 0.54 (95% CI, 0.43 to 0.65) and the specificity was 0.79 (95% CI, 0.73 to 0.84). The probability reduction for having a high-risk finding following both negative VOC and FIT will be 24% if both tests are applied sequentially. (4) Conclusion: The diagnostic performance of VOC is superior to FIT for the detection of a high-risk finding. The performance further improves when VOC is applied together with FIT sequentially (VOC first and then FIT). VOC alone or the combination of VOC and FIT can be used as a triage tool for patients awaiting colonoscopy within a polyp surveillance population, especially in resource-constrained healthcare systems.

12983 colonoscopies were performed during this period. 547 (age range 30-98 years) cases of CRC were diagnosed, 54% of them were males and 48 (8.7%) were less than 50 years of age. Clinical presentation and other characteristics were compared between young and old illustrated in table 1.Most common clinical presentations in young were; Anaemia (40%) Rectal bleeding(40%), change in bowel habits-CIBH (12%) while older patients were presented with anaemia(22%), CIBH (19%), rectal bleeding (21%) and abnormal imaging(19%). Significant proportion of young patients showed thrombocytosis when compared to older individuals (23% vs 14%, p=0.03).Most common sites were rectum and SC in both cohorts. In older population 43% of CRC were in proximal colon while only 14% in young had a proximal CRC (p=0.01)Majority of the CRC were adenocarcinoma (90%), and the remainder were anal squamous, neuro endocrine. 4.7% of cancers were not confirmed by histology.Significant proportion of patients were diagnosed at an advanced stage (3 and above) 31% and 32% in older and younger age group respectively. 59% of our cohort had elective or emergency surgery while the rest were treated with a palliative intent. One year mortality was 12.5% and 19% for young and older cohort respectively. 5 year survival rate was higher in young patients than older (77.8% vs 69.2%). Conclusions In our cohort younger CRCs presented with anaemia and rectal bleeding while older cohort with CIBH and anaemia/rectal bleeding. Thrombocytosis was a distinct feature in young CRCs. Even through significant proportion of younger CRCs presented with advanced disease, 5 year survival rate was higher in young.