NICE: updated guidelines on the management of colorectal cancer

  • National Institute for Health and Care Excellence

  • curated by Dawn O'Shea
  • Clinical Guidance Summaries
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NICE has published updated guidelines on the management of colorectal cancer.

Key recommendations include the following:

  • Consider daily aspirin for ≥2 years in people with Lynch syndrome.
  • For early rectal cancer (cT1-T2, cN0, M0) offer transanal excision (TAE), endoscopic submucosal dissection (ESD) or total mesorectal excision (TME).
  • Do not offer preoperative radiotherapy for early rectal cancer unless as part of a clinical trial.
  • Offer surgery, preoperative radiotherapy or chemoradiotherapy for cT1-T2, cN1-N2, M0, or cT3-T4, any cN, M0 rectal cancer.
  • Where surgery is deferred, encourage participation in a clinical trial and ensure data is collected via a national registry.
  • Only consider robotic surgery within established programmes.
  • Consider referral for locally-advanced primary or recurrent rectal cancer that might need multi-visceral or beyond-TME surgery.
  • Specialist hospitals should perform ≥10 major resection for rectal cancer per year and individual surgeons should perform ≥5.
  • Consider preoperative systemic anti-cancer therapy for cT4 colon cancer.
  • For stage III colon or rectal cancer treated with short-course radiotherapy or no preoperative treatment, offer:
  1. Capecitabine with oxaliplatin (CAPOX) for 3 months.
  2. Oxaliplatin with 5-fluorouracil and folinic acid (FOLFOX) for 3-6 months
  3. Fluoropyrimidine (e.g. capecitabine) for 6 months.
  • Consider stenting for acute left-sided large bowel obstruction.
  • Test for RAS and BRAF V600E mutations in people with metastatic CRC suitable for systemic anti-cancer treatment.
  • For liver metastases consider:
  1. Simultaneous or sequential resection.
  2. Perioperative systemic anti-cancer therapy.
  3. Chemotherapy with local ablative techniques.
  • Do not offer selective internal radiation therapy (SIRT) as first-line treatment for liver metastases unsuitable for local treatment.
  • 15. Consider metastasectomy, ablation or stereotactic body radiation therapy for lung metastases.
  • 16. Consider biopsy for single lung lesions to exclude primary lung cancer.