Intended for healthcare professionals

Practice Clinical Updates

Management of colorectal cancer

BMJ 2019; 366 doi: (Published 22 August 2019) Cite this as: BMJ 2019;366:l4561

Linked Practice

Colorectal adenocarcinoma: risks, prevention and diagnosis

  1. Kilian G M Brown, general surgery registrar,1 2 3,
  2. Michael J Solomon, consultant colorectal surgeon and professor of surgery1 2 3 4,
  3. Kate Mahon, consultant medical oncologist4 5,
  4. Sarah O’Shannassy, clinical nurse consultant2 3
  1. 1Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia
  2. 2The Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, Australia
  3. 3Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
  4. 4University of Sydney, New South Wales, Australia
  5. 5Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, Australia
  1. Correspondence to M J Solomon professor.solomon{at}

What you need to know

  • In patients with newly diagnosed colorectal cancer, order a test for serum carcinoembryonic antigen (CEA) level and computed tomography (CT) scan of the chest, abdomen, and pelvis for disease staging

  • Laparoscopic surgery is the standard of care for colon cancer, but its role in rectal cancer is debated

  • Patients with colorectal cancer are at high risk of malnutrition, particularly those undergoing chemoradiotherapy for rectal cancer

  • Most patients undergoing sphincter preserving surgery (ie, without permanent colostomy) experience bowel dysfunction. Urinary and sexual dysfunction is common after rectal cancer surgery

  • Following surgery, review serum CEA level at least every six months for three years and order at least two CT scans of the chest, abdomen, and pelvis in the first three years to detect recurrence

Colorectal cancer represents the third most commonly diagnosed cancer and is the fourth most common cause of cancer related mortality globally.1 The highest incidence and mortality rates are seen in high income countries.2

Surgical resection is the mainstay of treatment. Systemic chemotherapy and local pelvic radiotherapy are important adjuvant treatment modalities. The primary care physician plays a critical role in coordinating increasingly complex multi-modal management strategies for patients with colorectal cancer. This article provides an overview of contemporary management of colorectal cancer for general practitioners and other non-specialists.

The presentation and diagnosis of colorectal cancers have been covered recently in another article in The BMJ.3

What investigations to order before surgery?

Endoscopic biopsy followed by histology of the specimen is essential to confirm a new diagnosis of colorectal cancer. Following this, several investigations are necessary for clinical staging. These inform prognosis and guide subsequent management. Some can be arranged by the primary care physician.

Primary care physicians

UK and Australian guidelines45 advise obtaining a computed tomography (CT) scan of the chest, abdomen, and pelvis to assess the extent of local …

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