Treatment principles for colorectal cancer

Once colorectal cancer is identified, further management should be handed over to the relevant multidisciplinary team (MDT). An individualised programme of treatment and care should be created by the MDT after discussing with the patient (1).

Localised disease

• surgical resection of the tumour is the main curative treatment in patients with localised disease (2).
  • surgery should be avoided when the risks outweigh the potential benefits e.g. - in patients who are medically unfit or with a tumour which cannot be cured by surgery
  • prior to surgery, all patients should be informed about the possibility of having a stoma, why it might be necessary, and how long it might be needed for
  • complete colonic examination by colonoscopy, CT colonograpgy or barium enema should be carried out, ideally preoperatively (3)
  • laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable (4)
• patients presenting with acute large bowel obstructions, colonic stents should be considered (1).
• further treatment with adjuvant chemotherapy should be considered for high-risk stage II and stage III (Dukes' C) cancer following surgery (1)

Metastatic disease

• the best possible treatment method for metastatic colorectal cancer should be determined during the MDT team meeting and may vary according to the site and extent of the disease and the performance status, organ function and comorbidity of the patient (3).
• if present, priority should be given to control symptoms from the primary tumour (4)

Reference:

• (1) The NHS bowel cancer screening programme. Information for primary care
• (2) Cunningham D et al. Colorectal cancer. Lancet. 2010;375(9719):1030-47
• (3) Scottish Intercollegiate Guidelines Network 2011. Diagnosis and management of colorectal cancer.
• (4) National Institute for Health and Clinical Excellence (NICE) 2011. Colorectal cancer: the diagnosis and management of colorectal cancer