Intended for healthcare professionals

Rapid response to:

Practice Clinical Updates

Management of colorectal cancer

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4561 (Published 22 August 2019) Cite this as: BMJ 2019;366:l4561

Linked Practice

Colorectal adenocarcinoma: risks, prevention and diagnosis

Rapid Response:

Re: Management of colorectal cancer

We thank Dr Jones for his comments regarding our recent article on the management of colorectal cancer. The information provided in our article is intended for a global audience. While the approach to the management of this group of patients will be similar internationally, there are practical and logistical differences between healthcare systems which result in various interventions being implemented differently. This includes who arranges and coordinates particular aspects of care (i.e. general practitioner, oncologist or surgeon).

Current UK, Australian and American guidelines recommend a CT of the chest, abdomen and pelvis for disease staging in patients with a new diagnosis of primary colorectal cancer (1-3). Similarly, all three guidelines recommend serial CEA measurements after curative resection. In Australia, both staging imaging and serum CEA measurements may be arranged by the general practitioner, specialist surgeon, oncologist or another physician, however this may vary between countries.

We would also note that our article deals specifically with patients with a diagnosis of colorectal cancer. The presentation and diagnosis of colorectal cancer has been covered recently in another article in The BMJ (4).

1. National Institute for Health and Care Excellence. Colorectal cancer: The Diagnosis and Management of colorectal cancer. United Kingdom: National Institute for Health and Care Excellence. 2011. https://www.nice.org.uk/guidance/cg131

2. National Health and Medical Research Council. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Australia. 2017. https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer

3. National Comprehensive Cancer Network. Colon Cancer Guidelines Version 2.2019. https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf

4. Thrumurthy SB, Thrumurthy SSD, Gilbert CE, Ross P, Haji A. Colorectal adenocarcinoma: risks, prevention and diagnosis. BMJ 2016;354:3590. 10.113e/bmj.i359027418368

Competing interests: No competing interests

15 September 2019
Kilian GM Brown
General Surgery Registrar
Prof Michael J Solomon
Royal Prince Alfred Hospital, Sydney, Australia
PO Box M157, Royal Prince Alfred Hospital, NSW 2050, Australia