Intended for healthcare professionals

Practice Guidelines

Colorectal cancer: summary of NICE guidance

BMJ 2020; 368 doi: (Published 02 March 2020) Cite this as: BMJ 2020;368:m461
  1. Nathan Bromham, senior systematic reviewer1,
  2. Maija Kallioinen, guideline lead1,
  3. Peter Hoskin, chair of Guideline Committee and consultant clinical oncologist2,
  4. R Justin Davies, topic advisor and consultant colorectal surgeon3
  5. on behalf of the Guideline Committee
  1. 1National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, UK
  2. 2Mount Vernon Hospital, Northwood HA6 2RN, UK and University of Manchester
  3. 3Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
  1. Correspondence to: R J Davies justindavies2000{at}

What you need to know

  • Long term use of aspirin may prevent colorectal cancer in people with Lynch syndrome, a group with a high risk of colorectal cancer

  • Treatment options for early rectal cancer include endoscopic and surgical treatments

  • A shorter duration of adjuvant chemotherapy for three months can be effective and with lower side effects compared with the standard six months for people with lymph node-positive colorectal cancer

  • Colonic stenting is now an option for treatment with curative intent of acute left sided large bowel obstruction

  • Low anterior resection syndrome (LARS) is a common long term side effect for people who have undergone sphincter-preserving surgery for colorectal cancer

Colorectal cancer (cancer of the colon, rectum, or bowel) is the fourth most common cancer in the UK, with over 42 000 new cases diagnosed each year.1 Survival rates have improved, with a five year survival rate of almost 60% now.2

This article summarises recent recommendations from the update of the National Institute for Health and Care Excellence (NICE) guideline for the diagnosis and management of colorectal cancer.3 The update focuses on the management of colorectal cancer, reflecting new research evidence in this area.

What’s new in this guidance

  • Aspirin is recommended for the prevention of colorectal cancer in people with Lynch syndrome

  • Three months of adjuvant chemotherapy is recommended as an alternative to six months for people with stage III colon cancer (pT1-4, pN1-2, M0) or stage III rectal cancer (pT1-4, pN1-2, M0) treated with short course radiotherapy or no preoperative treatment

  • Preoperative radiotherapy or chemoradiotherapy is recommended for people with rectal cancer that is cT1-T2, cN1-N2, M0 or cT3-T4, any cN, M0

  • Treatment options are recommended for metastatic colorectal cancer in the lung, liver, or peritoneum

  • Minimum case volumes are set for surgeons and institutions treating patients with rectal cancer

  • Recognition and assessment of low anterior resection …

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