Background: The aim of this study is to determine whether the 'Fast-Track' referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome. Background: The aim of this study is to determine whether the 'Fast-Track' referral system has changed the route by which patients present with colorectal cancer (CRC) and whether the route of presentation has any effect on clinical outcome. Results: A total of 558 patients were identified. One hundred ninety-seven patients (35.3%) were referred as FT, 108 (19.4%) presented acutely and 253 patients (45.3%) presented via other routes (non-FT). Over the study period, the route of presentation did not change significantly (P = 0.135). There was no significant difference between FT and non-FT groups in terms of the proportion of patients undergoing potentially curative surgery (70.6 vs 74.3%, P = 0.092) or with node-negative disease (48.2 vs 52.2%, P = 0.796) nor was there any difference in 2-year or 5-year survival (74.1 vs 73.9%, P = 0.837 and 52.3 vs 53.8%, P = 0.889, respectively). Patients who presented acutely were less likely to undergo curative resection, had more advanced disease and had worse 2- and 5-year survival. Conclusions: The Fast-Track referral system has not affected the route by which patients present with CRC nor has it had any effect on clinical outcomes. Alternative strategies are required if the desired improvement in outcomes is to be achieved. [ABSTRACT FROM AUTHOR]