Diagnosis and management of colorectal cancer: summary of NICE guidance.

Colorectal cancer is the third leading cause of death from cancer in the United Kingdom, with a lifetime risk of about 2% in England and Wales, and its incidence is rising.1 The outcome for people with colorectal cancer is improving, but the overall five year survival rates are still lower than 60%.1 There is a need for greater accuracy in diagnosis and staging, more appropriate use of neoadjuvant and adjuvant therapies when treating potentially curable disease, and more effective use of resources when managing patients with advanced disease. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of people with colorectal cancer in secondary care.2 Recommendations for referral from primary care for patients with suspected colorectal cancer are in the NICE clinical guideline 27.3 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Investigations for diagnosis and staging #### Confirming a diagnosis of colorectal cancer The recommendations in this section refer to people whose condition is being managed in secondary care. For recommendations for urgent referral from primary care for patients with suspected colorectal cancer, see the NICE clinical guideline 27.3