The Management of Colorectal Cancers

■ Colorectal (bowel) cancer is the second most common cause of cancer death in England and Wales. Early detection and good management result in improved survival rates. ■ Flexible sigmoidoscopy is the most appropriate initial investigation for the majority of patients with left sided colon symptoms. ■ There is a clear correlation between colonoscopy completion rates and the number and frequency of examinations performed. ■ Nurses and GPs with appropriate training can perform endoscopy safely and accurately. ■ Higher patient volumes and greater specialisation among surgeons are associated with better outcomes. ■ Total mesorectal excision (TME) for patients with rectal cancer – is associated with reduced local recurrence and improved long term survival. ■ Increasing the number of lymph nodes in a surgical specimen improves the accuracy of staging at histopathology. ■ Colorectal stents are effective for temporary relief of acute intestinal obstruction, so avoiding emergency surgery. Expanding metal stents can provide good, and cost-effective, palliation. ■ The use of chemoradiotherapy in the treatment of anal cancer has been shown to provide significant improvements in colostomy-free and disease-free survival. ■ Follow-up is efficient and cost-effective if patients at higher risk of recurrence are followed up more intensively than those at lower risk.