19th July 2023

Colorectal Cancer (CRC)

CRC is the 3rd most common cancer in the Western world. The most common histology type is adenocarcinoma. Risk factors include increasing age, male gender, Caucasian or Black ethnicity, family history, obesity, physical inactivity and high red meat consumption. Symptoms depend on the site of the tumour but include abdominal pain, PR bleeding and change in bowel habit. Signs include an unexplained iron deficiency anaemia, palpable abdominal or rectal masses and evidence of weight loss. The gold standard investigation for diagnosis is colonoscopy with biopsy, however, CT colonography can be used if colonoscopy is contraindicated or inappropriate. Once a confirmed diagnosis is made, a staging CT of the chest, abdomen and pelvis is required. Management involves an MDT-based decision, considering factors including TNM staging, the patient’s performance status and patient preference. Localised CRC is usually managed with curative surgical resection and is only avoided if the risks outweigh the benefits. This may be preceded or followed up by radiotherapy and/or chemotherapy. Advanced metastatic or inoperable tumours will be managed with a palliative approach, including palliative surgery, chemotherapy and hormone therapy. In the UK, bowel cancer screening is offered to everyone aged 60 to 74 years old every 2 years in the form of a home Faecal Immunochemical Test (FIT).