Intended for healthcare professionals

Clinical Review

Colorectal cancer

BMJ 2007; 335 doi: (Published 04 October 2007) Cite this as: BMJ 2007;335:715
  1. Anne B Ballinger, consultant gastroenterologist,
  2. Clive Anggiansah, senior house officer in gastroenterology
  1. Homerton University Hospital NHS Foundation Trust, London E9 6SR
  1. Correspondence to: A B Ballinger anne.ballinger{at}

Summary points

  • The lifetime risk of developing colorectal cancer is about 5%

  • Increasing age and a family history of colorectal cancer are the greatest risk factors for the disease

  • Patients presenting with suspicious symptoms and signs should be referred and investigated urgently in a specialised unit

  • Colonoscopy and computed tomographic colonography are of equal sensitivity for detection of colorectal cancer

  • Colonoscopy allows biopsy of suspicious lesions and removal of polyps

  • Population screening by testing for faecal occult blood has begun in the United Kingdom

Colorectal cancer is common, the presenting symptoms are non-specific, and the stage of disease at diagnosis is closely related to survival. In this review we discuss disease presentation, criteria for urgent referral of patients to specialist care, and recent developments in the implementation of national screening programmes, which aim to reduce mortality from this common disease. Many general practitioners will also refer patients with suspected colorectal cancer ?direct to test? and this review covers the various modalities for investigation of patients with colorectal symptoms.

Sources and selection criteria

We searched PubMed for recent papers using the keywords ?colorectal cancer?, ?screening?, ?investigation?, and ?incidence?. We also searched the Cochrane Database of Systematic Reviews using the search terms ?colorectal cancer? and ?inflammatory bowel disease?. In addition we used our personal reference archive.

How common is colorectal cancer?

In the Western world colorectal cancer is the second most common cancer in women after breast cancer and the third most common in men after lung and prostate cancer.1 2 Rates vary largely worldwide, being lowest in Africa and Asia and highest in Europe, North America, and Australasia. In the United Kingdom the lifetime incidence of colorectal cancer in people at average risk is 5% and the age standardised incidence rate is 44.3 per 100?000 population.3

How does colorectal cancer develop?

In most cases colorectal cancers arise from dysplastic adenomatous polyps. A multistep process involves …

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