Sometimes I think that the treatment of cancer in the United Kingdom has lost its way; there are just over 400 clinical and medical oncologists in Britain. Some may consider this an advantage. The proportion of patients receiving cytotoxic drugs for cancer is probably less here than any other Western country. Is this approach justified? Recently, the trial of global utilisation of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO) showed that tissue plasminogen activator reduced the absolute death rate after myocardial infarction by 1% compared with streptokinase.1 The authors described it as “a major stepwise increment in survival beyond that of the established standard.”2 When the difference between the two treatments was analysed it was calculated to cost $220000 to save a single life.3 Although real progress in medicine is relatively slow, a reassessment of the role of cytotoxic drugs in the management of common solid tumours is long overdue. Where better to start than colonic cancer, a tumour in which chemotherapy is widely …