Practice Guidelines

Diagnosis and management of colorectal cancer: summary of NICE guidance

BMJ 2011; 343 doi: (Published 09 November 2011) Cite this as: BMJ 2011;343:d6751
  1. G J Poston, consultant surgeon1,
  2. D Tait, consultant clinical oncologist2,
  3. S O’Connell, researcher3,
  4. A Bennett, assistant centre manager3,
  5. S Berendse, information specialist3
  6. On behalf of the Guideline Development Group
  1. 1Aintree University Hospital, Liverpool L9 7AL, UK
  2. 2Royal Marsden Hospital, London SW3 6JJ, UK
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
  1. Correspondence to: G J Poston graeme.poston{at}

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

  • Advise the patient that more than one investigation may be necessary to confirm or exclude a diagnosis of colorectal cancer.

  • Offer colonoscopy to patients without major comorbidity. If a lesion suspicious of cancer is detected, perform a biopsy unless contraindicated (for example, in patients with bleeding disorders).

  • For patients with major comorbidity, offer flexible sigmoidoscopy followed by a barium enema. If a lesion suspicious of cancer is detected perform a biopsy unless …

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