Colorectal Cancer
Colorectal cancer is usually an adenocarcinoma of the colon or rectum whose presentation, local treatment and chance of cure depend on site, TNM stage and tumour biology; FIT helps select symptomatic patients for referral but cannot safely rule cancer out when clinical concern persists.
Definition
Colorectal cancer is a malignant epithelial tumour of the colon or rectum, most often adenocarcinoma arising from a conventional adenomatous or serrated precursor or through mismatch-repair-deficient carcinogenesis. Management is organised by anatomical site, TNM stage, resectability, molecular biology, physiological fitness and patient goals.
Epidemiology
Risk rises with age but younger adults can be affected. Important risk factors include previous colorectal adenoma or cancer, inflammatory bowel disease, obesity, smoking, alcohol, diets high in processed or red meat, physical inactivity and family history. Lynch syndrome and polyposis syndromes account for a minority of cases but have major implications for the patient and relatives. England, Scotland and Wales currently invite adults aged 50 to 74 for home FIT every 2 years, while Northern Ireland invites ages 60 to 74; screening is for people without symptoms and is separate from Lynch surveillance.
Pathophysiology
Colorectal carcinogenesis is heterogeneous. The conventional adenoma pathway commonly involves chromosomal instability and WNT or APC-pathway disruption, followed by selection of additional growth, invasion and survival drivers; it is not a compulsory APC then KRAS then TP53 sequence. The serrated pathway often involves epigenetic silencing and may overlap with BRAF-driven biology, while deficient DNA mismatch repair creates microsatellite instability and a high mutation burden, either sporadically or through Lynch syndrome. Invasive cells spread through the bowel wall, regional lymphatics, portal circulation to the liver, systemic circulation to the lungs and across the peritoneum. Local narrowing, mucosal ulceration and intermittent bleeding explain obstruction, iron deficiency and visible bleeding.
First principles
Colorectal carcinogenesis follows several pathways, not one fixed mutation sequence
Many sporadic cancers develop through chromosomal instability in an adenoma, often involving APC pathway disruption and later additional driver changes, but APC, KRAS and TP53 are not a universal or compulsory linear sequence. Serrated neoplasia and mismatch-repair deficiency with microsatellite instability are important alternative routes. This long premalignant phase explains why screening and complete polyp removal can prevent some cancers, while tumour MMR, MSI, RAS and BRAF results can affect inherited-risk assessment and systemic treatment.1,2,3
Tumour site changes the usual presentation, but the patterns overlap
Proximal tumours may bleed slowly into liquid stool and present with iron-deficiency anaemia, fatigue or weight loss before causing obstruction. Distal colonic and rectal tumours more often cause visible bleeding, altered bowel habit, tenesmus or obstruction because stool is more formed and the lumen is narrower. These are tendencies, not exclusion rules: any colorectal cancer may be asymptomatic, may bleed intermittently and may present with obstruction or perforation.4,5,6
FIT estimates referral risk; it does not close the diagnostic pathway
Quantitative symptomatic FIT detects human haemoglobin and helps primary care select people for the suspected colorectal cancer pathway. A result at or above the NICE threshold requires referral, but a lower result does not negate a palpable mass, persistent unexplained symptoms, anaemia or strong clinical concern. Failure to return a sample is also not reassurance. Screening FIT is a separate programme for people without symptoms.4,7,3
Site, stage, resectability and biology determine intent
Colon and rectal cancers share TNM staging but need different local strategies: rectal MRI predicts the pelvic resection plane and local recurrence risk, so radiotherapy or chemoradiotherapy may precede surgery, whereas colon cancer is usually resected first unless locally advanced features justify preoperative systemic treatment. Distant spread does not automatically mean incurable disease; selected liver, lung or peritoneal metastases may be treated with resection or local therapy after specialist multidisciplinary review.2,5
Presentation
Presentation ranges from an abnormal screening test or occult iron deficiency to rectal bleeding, change in bowel habit, abdominal pain, weight loss or a palpable mass. Obstruction, perforation with sepsis and haemodynamically important bleeding are emergency presentations.4,7,2,8,9,10
Cardinal features
- Persistent change in bowel habit, including looser or more frequent stool
- Rectal bleeding or blood mixed with stool
- Iron-deficiency anaemia, fatigue, exertional breathlessness or pallor
- Unexplained abdominal pain, weight loss, reduced appetite or early satiety
- Palpable abdominal or rectal mass
- Tenesmus, urgency, incomplete evacuation or narrow-calibre stool with rectal disease
- Intermittent colicky pain, distension, vomiting or constipation as the lumen narrows
- Incidental detection after a positive bowel-screening FIT
Red flags
- Colicky pain, progressive distension, vomiting and failure to pass stool or flatus: suspect large-bowel obstruction and arrange emergency surgical assessment
- Sudden severe pain, peritonism, fever, hypotension, confusion or raised lactate: suspect perforation or sepsis and escalate immediately for resuscitation and source control
- Ongoing large-volume rectal bleeding, syncope, tachycardia or hypotension: activate the acute lower gastrointestinal bleeding pathway
- A rectal mass or unexplained anal mass or ulceration: consider suspected cancer referral without waiting for FIT
- Persistent unexplained symptoms, iron-deficiency anaemia, an abdominal mass or strong clinical concern despite FIT below threshold: do not use the result to defer appropriate secondary-care referral
- Very young onset, multiple polyps, several affected relatives or a Lynch-spectrum family history: involve clinical genetics through the current genomic-testing pathway
Investigations
Clinical assessment, abdominal examination and digital rectal examination
Clarify symptom duration, bleeding, bowel habit, weight loss, obstructive features, comorbidity, medicines, inflammatory bowel disease, previous polyps and family history. Examine for anaemia, cachexia, distension, tenderness, organomegaly, lymphadenopathy, an abdominal mass and a rectal lesion. A normal rectal examination does not exclude proximal cancer.
Expected finding: A mass, blood, abdominal distension or iron-deficiency features increase concern, but early colorectal cancer may have no abnormal examination finding.
4,5,9Quantitative FIT in symptomatic primary-care assessment
Offer FIT using a NICE-recommended analyser to adults with an abdominal mass, change in bowel habit or iron-deficiency anaemia; to adults aged 40 or over with unexplained weight loss and abdominal pain; to those under 50 with rectal bleeding plus unexplained abdominal pain or weight loss; to those aged 50 or over with unexplained rectal bleeding, abdominal pain or weight loss; and to those aged 60 or over with anaemia even without proven iron deficiency. Offer it even after a previous negative screening FIT.
Expected finding: Faecal haemoglobin at or above 10 µg Hb/g faeces requires suspected colorectal cancer pathway referral. Below this threshold, or if the sample is not returned, safety-net actively and do not delay referral when symptoms, a mass, anaemia or clinical judgement still suggest cancer. A rectal mass or unexplained anal mass or ulceration does not require FIT before referral is considered.
4,7Blood tests and baseline CEA
Check FBC, ferritin and iron studies, renal function, electrolytes, liver profile and coagulation as clinically indicated; arrange group-and-save or crossmatch when bleeding or surgery may require it. Record CEA after diagnosis as a baseline for follow-up, not as a screening or exclusion test.
Expected finding: Iron-deficiency anaemia may be the only clue, while liver-profile abnormalities can suggest metastatic disease. Normal haemoglobin, liver tests or CEA do not exclude cancer.
2,9,5Colonoscopy with biopsy and whole-colon assessment
Direct visualisation defines the lesion, obtains tissue for histological confirmation and examines the remaining colon for synchronous cancer or polyps. Tattooing may help localisation. Complete or schedule whole-colon clearance when obstruction or an incomplete procedure prevents it initially.
Expected finding: An irregular, ulcerated, friable or stenosing lesion with biopsy usually confirming adenocarcinoma; additional polyps or a synchronous tumour may alter the operative plan.
11,5Colonoscopy or CT colonography as the first whole-colon test
In the symptomatic timed diagnostic pathway, clinical triage may select colonoscopy or CT colonography according to clinical suitability, patient factors and the locally agreed straight-to-test protocol; CTC is not confined to a failed colonoscopy. Colonoscopy supplies biopsy and can remove polyps, while CTC can evaluate the colon without endoscopic intubation but cannot provide histology. After an abnormal screening FIT, assessment follows the screening programme and colonoscopy is usual; CTC is an alternative when the screening team judges colonoscopy unsuitable.
Expected finding: Either test may show focal mural thickening, an annular stricture, polypoid mass or synchronous lesion. A lesion found only on CTC still needs an appropriate tissue route where feasible.
5,3Histopathology and universal tumour MMR or MSI testing
Pathology confirms type and grade and, after resection, reports depth, lymph nodes, margins, lymphovascular or perineural invasion and other prognostic features. Report stage using the current UICC TNM system and state its edition; current UK colorectal reporting uses UICC TNM9. Dukes staging is historical and should not replace TNM in MDT decisions. At first diagnosis, test every colorectal cancer using mismatch-repair immunohistochemistry or microsatellite-instability testing; do not delay treatment while awaiting the result.
Expected finding: The report provides pathological TNM category and risk features. Loss of MLH1, MSH2, MSH6 or PMS2 expression, or high MSI, triggers the NICE sequential Lynch pathway. MLH1 loss or MSI is followed by BRAF V600E and MLH1-promoter hypermethylation testing; unexplained abnormality, or loss of MSH2, MSH6 or PMS2, prompts germline assessment.
1,2,12CT chest, abdomen and pelvis for staging
Assess local extension, regional nodes, liver, lungs, peritoneum and other distant sites before definitive treatment. Interpret radiology with histology, operative fitness and resectability at the colorectal MDT rather than equating any metastasis with automatic palliation.
Expected finding: TNM stage and a map of potentially resectable or locally treatable metastatic disease; indeterminate lesions may require targeted specialist imaging or biopsy.
2,5Dedicated pelvic MRI for rectal cancer
Define tumour height, T and N stage, relationship to the mesorectal fascia, sphincter and adjacent organs, and use the result to plan local excision, total mesorectal excision and any preoperative radiotherapy or chemoradiotherapy. Selected very early lesions may need additional local staging within the specialist service.
Expected finding: A threatened resection margin, nodal disease, extramural spread or sphincter involvement changes the neoadjuvant and operative strategy.
2,5RAS and BRAF V600E testing in metastatic disease
Test all metastatic colorectal cancers that may receive systemic anticancer treatment because RAS and BRAF V600E status, together with MMR or MSI, helps select targeted treatment or immunotherapy.
Expected finding: RAS wild type, BRAF V600E mutation or dMMR/MSI-high status directs the oncology team toward different NICE-authorised options and away from ineffective classes.
2Management
| Step | Detail | Source |
|---|---|---|
| Treat obstruction as a surgical emergency | Use ABCDE, keep the patient nil by mouth, obtain urgent intravenous access and resuscitate, provide analgesia and antiemetic treatment, correct electrolyte disturbance, measure lactate and arrange contrast CT if this will not delay life-saving intervention. Seek immediate senior colorectal, anaesthetic and radiology input; use nasogastric decompression when vomiting or marked distension warrants it. For acute left-sided malignant obstruction, consider a colonic stent when intent is palliative; when cure remains possible and the patient is suitable, NICE advises offering a choice of stenting or emergency surgery after specialist discussion. Perforation or peritonitis requires the perforation pathway rather than stenting.2,6 | NICE NG151 |
| Resuscitate perforation, peritonitis or sepsis and obtain urgent source control | Start emergency ABCDE management, involve colorectal surgery, anaesthesia and critical care immediately, obtain bloods including lactate and cultures where this does not delay treatment, give intravenous fluid and empirical antimicrobials according to the local intra-abdominal infection and sepsis pathway, and arrange urgent CT only if sufficiently stable. Drainage, diversion or resection is determined by the site, contamination, tumour stage and physiological reserve; do not delay source control in an unstable patient (see BNF).8,2,6 | NICE NG253 and colorectal emergency practice |
| Control haemodynamically important lower gastrointestinal bleeding | Resuscitate, obtain large-bore intravenous access, FBC, renal profile, coagulation and group-and-save or crossmatch, review antithrombotic treatment through the acute-bleeding pathway and activate the local major-haemorrhage protocol when required. Persistent haemodynamic instability or suspected active bleeding after initial resuscitation requires urgent CT angiography; a positive study should lead promptly to angiography with embolisation where appropriate. Use endoscopic therapy when suitable and reserve emergency laparotomy for exceptional cases after localisation has been attempted.9 | BSG acute lower gastrointestinal bleeding guideline |
| Use the current symptomatic FIT referral pathway with explicit safety-netting | Offer quantitative FIT to the NG12 symptom and age groups and refer on a suspected colorectal cancer pathway when faecal haemoglobin is at least 10 µg Hb/g faeces. Do not wait for FIT before considering referral for a rectal mass or unexplained anal mass or ulceration. When FIT is below threshold or not returned, arrange review, support sample completion and refer anyway if symptoms persist, a mass or anaemia is present, or clinical concern remains strong. Record who will check the result and what should trigger re-contact.4,7 | NICE NG12 and HTG690 |
| Keep population screening separate from symptomatic assessment | Population screening is for people without symptoms and uses its own programme thresholds and follow-up: never apply the symptomatic referral threshold to a screening result. England, Scotland and Wales currently invite adults aged 50 to 74 every 2 years; Northern Ireland invites ages 60 to 74 every 2 years. England and Scotland allow people aged 75 or over to request a kit every 2 years. After an abnormal screening FIT, programme assessment usually leads to colonoscopy, with CTC reserved for people whom the screening team judges unsuitable for colonoscopy. A previous or current negative screening FIT must never replace NG12 assessment of new symptoms.3,13,14,15,4 | Current national bowel screening programmes and NICE NG12 |
| Confirm histology, complete staging and agree intent at the colorectal MDT | Combine colonoscopy or CT colonography, biopsy, CT staging, rectal MRI when applicable, pathology, MMR or MSI testing, performance status, frailty and patient goals. Distinguish colon from rectal treatment, define resectability and record whether intent is curative, disease-controlling or symptom-focused. Refer locally advanced or recurrent rectal disease that may require surgery beyond total mesorectal excision to a specialist exenterative centre.2,1,5,12 | NICE NG151 and NICE HTG430 |
| Resect localised colon cancer with its lymphovascular pedicle and regional nodes | Choose the segmental colectomy from tumour site and vascular drainage, aiming for an oncological en-bloc resection and clear margins. Laparoscopic surgery is an alternative to open surgery when either is suitable, with conversion or an open approach when anatomy, invasion, emergency physiology or operative safety requires it. For cT4 colon cancer, consider preoperative systemic anticancer therapy at the MDT before resection (see BNF).2,16 | NICE NG151 |
| Match early rectal cancer treatment to local stage and functional priorities | For cT1 to cT2, cN0, M0 rectal cancer, offer shared decision-making about transanal excision techniques, endoscopic submucosal dissection or total mesorectal excision, explaining oncological certainty, need for completion surgery, stoma risk and bowel, urinary and sexual function. Do not offer preoperative radiotherapy for early rectal cancer outside a clinical trial. Standard rectal resection may be laparoscopic or open as indicated; robotic surgery belongs in established, audited programmes, and transanal total mesorectal excision should only be used in formal research.2,17 | NICE NG151 and HTG603 |
| Use neoadjuvant treatment for higher-risk non-metastatic rectal cancer | Offer preoperative radiotherapy or chemoradiotherapy for rectal cancer staged cT1 to cT2 with cN1 to cN2, or cT3 to cT4 with any nodal stage, when M0, then offer resection when the disease is operable (see BNF). If there is a complete clinical and radiological response and the person wishes to defer surgery, explain the uncertainty in predicting durable response and recurrence, encourage trial or national-registry participation and use an intensive specialist surveillance protocol rather than routine follow-up.2,16 | NICE NG151 |
| Consider specialist contact X-ray brachytherapy only within its defined rectal-cancer indication | A colorectal cancer MDT with specifically trained colorectal and oncology specialists may consider low-energy contact X-ray brachytherapy when an early or locally advanced rectal tumour is 3 cm or smaller, is no more advanced than T3b N1 M0, and surgery is declined or carries unacceptably high risk. A larger tumour may become eligible after neoadjuvant downstaging to those limits. Use for metastatic rectal cancer only in formal research.18 | NICE HTG763 |
| Offer postoperative systemic treatment according to pathological risk and rectal preoperative treatment | For stage III colon cancer, offer 3 months of CAPOX. If CAPOX is unsuitable, offer FOLFOX with duration individualised by oncology, or a single fluoropyrimidine when combination treatment is unsuitable, taking account of pathological risk, fitness, comorbidity, toxicity and preference (see BNF). The same NICE adjuvant options apply to stage III rectal cancer treated with short-course preoperative radiotherapy or no preoperative treatment. NICE made no equivalent recommendation after long-course chemotherapy or chemoradiotherapy because applicable trial evidence was not identified. Do not state that every stage II cancer automatically requires chemotherapy; these decisions need individual MDT risk assessment.2,16 | NICE NG151 and BNF cytotoxic-drug guidance |
| Use molecular results for Lynch assessment and treatment selection | Ensure every new cancer has tumour MMR immunohistochemistry or MSI testing and complete the NICE reflex BRAF V600E and MLH1-promoter hypermethylation sequence where indicated. Refer for germline testing and clinical genetics when the tumour result remains suggestive, and use the current National Genomic Test Directory for inherited polyposis or strong familial phenotypes. Explain implications before testing and offer appropriate support because a germline result may change surveillance and enable cascade testing in relatives. In metastatic disease, obtain RAS and BRAF V600E status as well as MMR or MSI before systemic selection.1,2,10 | NICE HTG430, NG151 and NHS England National Genomic Test Directory |
| Keep confirmed-Lynch surveillance distinct from population screening and recurrence follow-up | For a confirmed pathogenic Lynch-syndrome variant, arrange high-quality colonoscopy every 2 years. Start at age 25 for MLH1, MSH2 or EPCAM-associated MSH2 inactivation and at age 35 for MSH6 or PMS2; the UK hereditary guideline usually continues surveillance to age 75, then individualises it according to fitness, previous cancer, surgery and remaining bowel. This is colonoscopic surveillance, not FIT screening, and retained colorectum still needs a specialist plan after a cancer resection.19,20 | BSG/ACPGBI/UKCGG hereditary colorectal cancer guideline and NHS England Lynch syndrome surveillance pathway |
| Treat metastatic disease through an organ-specific specialist MDT | Assess liver, lung and peritoneal disease for resection or local treatment before assigning non-curative intent. Selected liver metastases may undergo simultaneous or staged resection, perioperative systemic treatment or ablation; selected lung disease may undergo metastasectomy, ablation or stereotactic radiotherapy; isolated peritoneal metastases should be discussed with a nationally commissioned centre for possible cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. For systemic treatment, use performance status, goals, previous therapy, primary site and MMR or MSI, RAS and BRAF biology to select a fluoropyrimidine-based platform, checkpoint immunotherapy for eligible dMMR or MSI-high disease, anti-EGFR treatment for eligible RAS-wild-type disease, a BRAF-directed option for relevant previously treated disease, or anti-VEGF treatment when targeted therapy or immunotherapy is unsuitable, following current NICE technology appraisals and the BNF. Consider resection of an asymptomatic primary even in incurable metastatic disease only after a balanced discussion of operative risk, later obstruction or bleeding and systemic-treatment timing (see BNF).2,16 | NICE NG151 and current linked technology appraisals |
| Plan stoma care, rehabilitation, late-effect treatment and supportive care from the start | Before treatment, discuss whether a stoma is unlikely, temporary or permanent and arrange marking, education and follow-up with a trained stoma professional. For elective major or complex colorectal surgery, offer an enhanced recovery programme spanning preoperative, intraoperative and postoperative care, with early nutritional, functional and prehabilitation assessment. Explain possible effects on bowel, urinary and sexual function, fertility, body image and work. Monitor systemic-treatment toxicity, including persistent platinum-related neuropathy. After rectal treatment, ask directly about low anterior resection syndrome, use a validated score and escalate persistent frequency, urgency, clustering, incontinence or evacuation difficulty to specialist bowel-function care. Integrate symptom control and palliative care according to need, alongside active anticancer treatment when appropriate.2,21,5 | NICE NG151, NICE NG180 and NHS England timed colorectal diagnostic pathway |
| Use recurrence surveillance and lifelong safety-netting | After potentially curative surgery for non-metastatic colorectal cancer, measure CEA at least every 6 months and obtain at least 2 CT scans of the chest, abdomen and pelvis during the first 3 years. Arrange a clearance colonoscopy within 1 year of diagnosis and, if appropriate, another after 3 further years, individualising later surveillance for findings, inherited risk, age, comorbidity and life expectancy. Do not wait for a scheduled test if new bleeding, altered bowel habit, abdominal pain, weight loss, obstructive symptoms, a new mass or progressive systemic symptoms arise. Also provide clear routes for urgent stoma problems, postoperative complications and late effects.2,22,11 | NICE QS20, NICE NG151 and BSG/ACPGBI/PHE surveillance guideline |
Illustrations
Differentials
Haemorrhoids or anal fissure
An identifiable anorectal source may explain fresh bleeding, but does not exclude synchronous cancer; altered bowel habit, anaemia, weight loss, a mass or persistent bleeding still needs the cancer pathway.
Diverticular disease
Diverticular bleeding is often abrupt and painless, while diverticulitis usually causes left-sided pain and inflammation; endoscopic or radiological assessment is needed when cancer remains possible.
Inflammatory bowel disease or other colitis
Diarrhoea, urgency, bleeding and inflammation may dominate, but longstanding colitis increases colorectal neoplasia risk and biopsy is required to distinguish active colitis, dysplasia and cancer.
Irritable bowel syndrome
Chronic pain related to defaecation without bleeding, iron deficiency, weight loss, nocturnal symptoms or a mass supports IBS only after appropriate assessment; new late-onset or progressive symptoms need investigation.
Infective colitis
Acute diarrhoea with exposure history, fever and positive stool microbiology favours infection, but persistence or red flags require structural assessment.
Upper gastrointestinal or gynaecological blood loss
Alternative chronic blood loss can cause iron deficiency, but should not be assumed without investigating the gastrointestinal tract according to the presentation and risk.
Complications
- Large-bowel obstruction, closed-loop dilatation and ischaemia
- Tumour perforation, faecal peritonitis, abscess and sepsis
- Chronic iron-deficiency anaemia or acute lower gastrointestinal haemorrhage
- Local invasion, fistulation and ureteric or pelvic-organ obstruction
- Liver, lung, peritoneal and other metastatic disease
- Venous thromboembolism, malnutrition, cachexia and treatment interruption
- Anastomotic leak, wound infection, ileus, stoma complications and incisional hernia
- Low anterior resection syndrome, urinary or sexual dysfunction, infertility and chronic pelvic effects
- Systemic-treatment toxicity including cytopenia, mucositis, diarrhoea and persistent neuropathy
Prognosis
Outcome is driven chiefly by pathological stage, margin status, adverse histological features, tumour biology, emergency presentation, physiological reserve and whether all disease can be treated radically. Early node-negative disease is often curable by local or segmental resection, stage III disease can remain curable with surgery and adjuvant therapy, and carefully selected oligometastatic liver, lung or peritoneal disease may still enter a curative pathway. Recurrence risk and treatment burden should be discussed honestly without equating metastatic disease with inevitable palliation.
Guidelines
- Suspected cancer: recognition and referral (NG12) (NICE, 2015)
- Colorectal cancer: diagnosis and management (NG151) (NICE, 2020)
- Molecular testing strategies for Lynch syndrome in people with colorectal cancer (HTG430) (NICE, 2017)
- Quantitative FIT to guide colorectal cancer pathway referral in primary care (HTG690) (NICE, 2023)
References
- NICE, Molecular testing strategies for Lynch syndrome in people with colorectal cancer (HTG430)Published 22 Feb 2017
- NICE, Colorectal cancer: diagnosis and management (NG151)Published 29 Jan 2020 | Updated 15 Dec 2021
- NHS England, Bowel cancer screening programme overviewPublished 1 Jan 2015 | Updated 17 Mar 2026
- NICE, Suspected cancer: recognition and referral (NG12)Published 23 Jun 2015 | Updated 15 Apr 2026
- NHS England, Implementing a timed colorectal cancer diagnostic pathway, version 3.2 (PR2119)
- ACPGBI, Consensus guidelines in emergency colorectal surgeryPublished 27 Feb 2021
- NICE, Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care (HTG690)Published 24 Aug 2023
- NICE, Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253)Published 19 Nov 2025
- British Society of Gastroenterology, Diagnosis and management of acute lower gastrointestinal bleeding
- NHS England, National Genomic Test DirectoriesPublished 3 Aug 2018 | Updated 16 Jul 2026
- BSG/ACPGBI/PHE, Post-polypectomy and post-colorectal cancer resection surveillance guidelinePublished 27 Nov 2019
- Royal College of Pathologists, UICC TNM9 classification of colorectal tumours
- NHS inform, Bowel screening in Scotland
- Public Health Wales, Bowel screening
- nidirect, Bowel cancer screening
- BNF, Cytotoxic drugs treatment summary
- NICE, Transanal total mesorectal excision for rectal cancer (HTG603)Published 15 Dec 2021
- NICE, Low-energy contact X-ray brachytherapy for rectal cancer (HTG763)Published 13 Nov 2025
- BSG/ACPGBI/UKCGG, Guidelines for the management of hereditary colorectal cancerPublished 28 Nov 2019
- NHS England, Lynch syndrome colonoscopy surveillance care pathwayUpdated 6 Mar 2026
- NICE, Perioperative care in adults (NG180)Published 19 Aug 2020
- NICE, Colorectal cancer quality standard (QS20)Published 13 Aug 2012 | Updated 1 Feb 2022
Evidence checked: 2026-07-29
This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.