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 (eg, 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.
- Consider metastasectomy, ablation, or stereotactic body radiation therapy for lung metastases.
- Consider biopsy for single lung lesions to exclude primary lung cancer.