We are pleased to announce the publication of NICE guideline Colorectal cancer (NG151).
Colorectal cancer (cancer of the colon or rectum, or bowel cancer) is the fourth most common cancer in the UK, with over 41,000 new cases diagnosed each year according to Cancer Research UK.
Risk factors include increasing age, genetics and family history (particularly syndromes such as familial adenomatous polyposis and Lynch syndrome), inflammatory bowel disease and other dietary and lifestyle factors.
Survival rates have improved over the years, with almost 60% of the people diagnosed with colorectal cancer surviving for at least 5 years.
Survival is linked to disease stage at presentation, with better survival the earlier the disease is detected and treated.
Diagnosis and staging of colorectal cancer are well established with histology and appropriate imaging, and are not covered by this guideline update.
People with Lynch syndrome have an increased risk of colorectal cancer, with lifetime risk estimated to be between around 50 to 80%. The main strategy to prevent colorectal cancer in people with Lynch syndrome is regular screening with colonoscopy and polypectomy. This guideline recommends considering aspirin as another prevention strategy for colorectal cancer for people with Lynch syndrome.
Management of colorectal cancer has advanced over time with new treatment methods and strategies being trialled and used. Management of local disease may differ depending on the site of the cancer and this guideline separates treatment of rectal cancer from treatment of colon cancer where it differs. This guideline addresses issues such as treatment for early rectal cancer, preoperative chemotherapy or chemoradiotherapy for both rectal and colon cancer, surgical technique for rectal cancer, duration of adjuvant chemotherapy, management of locally advanced disease and colonic stents in acute large bowel obstruction. It also comments on the minimum surgical volumes for rectal cancer surgery by hospital and by surgeon.
The most common sites of colorectal cancer metastases are liver, lung and peritoneum and the guideline covers the management of these. In addition, the role of molecular biomarkers in guiding systemic anti-cancer therapy is addressed.
People who have been treated for colorectal cancer may have long-term side effects of their treatments. For example, low anterior resection syndrome (LARS) can have major impact on quality of life and daily living and it affects around 40% of those who have undergone sphincter-preserving surgery for rectal cancer. The guideline covers the assessment and management of LARS in primary care.
This guideline was developed by the National Guideline Alliance (NGA) in collaboration with a guideline committee consisting of clinical experts and patient representatives (lay members). It is for healthcare professionals, commissioners and for people with colorectal cancer, their families and carers.
"Colorectal cancer" (N151) is available on the NICE website from Wednesday 29 January 2020: