Clinical update

Colorectal cancer: improving quality of life and survival

New National Institute for Health and Care Excellence guidance on colorectal cancer covers the management of local disease and secondary tumours
An illustration representing colorectal cancer. New guidance covers the management of local disease and secondary tumours.

New National Institute for Health and Care Excellence guidance on colorectal cancer covers the management of local disease and secondary tumours

Essential information

Colorectal cancer cancer of the colon or rectum, also known as bowel cancer is the fourth most common cancer in the UK, with more than 42,000 new cases diagnosed each year, according to Cancer Research UK . Survival rates have improved over time, with almost 60% of people diagnosed with colorectal cancer surviving for at least five years, according to the National Institute for Health and Care Excellence (NICE) . Survival is linked to disease stage

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New National Institute for Health and Care Excellence guidance on colorectal cancer covers the management of local disease and secondary tumours

An illustration representing colorectal cancer. New guidance covers the management of local disease and secondary tumours.
Picture: iStock

Essential information

Colorectal cancer – cancer of the colon or rectum, also known as bowel cancer – is the fourth most common cancer in the UK, with more than 42,000 new cases diagnosed each year, according to Cancer Research UK. Survival rates have improved over time, with almost 60% of people diagnosed with colorectal cancer surviving for at least five years, according to the National Institute for Health and Care Excellence (NICE). Survival is linked to disease stage at presentation, with better chances of survival the earlier the disease is detected and treated.

What’s new?

NICE has published guidance to improve the quality of life and survival of people diagnosed with colorectal cancer. This replaces previous guidance from 2011 and covers the management of local disease and secondary tumours. NICE suggests that people with Lynch syndrome consider taking aspirin daily to help prevent them developing the disease. It highlights the importance of recognition of low anterior resection syndrome (LARS) following sphincter-preserving surgery.

Signs and symptoms

According to Bowel Cancer UK potential signs of colorectal cancer include anal bleeding or blood in the faeces, persistent and unexplained changes in bowel habit, unexplained weight loss, extreme tiredness for no obvious reason and pains or lumps in the abdomen.

Causes and risk factors

The NICE guidance states risk factors include increasing age, genetics and family history –particularly syndromes such as familial adenomatous polyposis and Lynch syndrome – inflammatory bowel disease and other dietary and lifestyle factors. People with Lynch syndrome have an increased risk of colorectal cancer, with lifetime risk estimated to be 50-80%.

How you can help your patient

  • Provide information on all treatment options available, including the potential benefits, risks, side effects and implications of treatments.
  • Advise people on the likelihood of needing a stoma, why it may be necessary and how long it might be needed. If relevant, have a trained stoma professional provide information on the care and management of stomas and on learning to live with a stoma.
  • Give information to people who have had treatment about possible short-term, long-term, permanent and late side effects that can affect quality of life, including pain, altered bowel, urinary or sexual function, nerve damage and neuropathy, as well as mental and emotional changes.
  • Give information on LARS to people who will potentially have sphincter-preserving surgery. Advise them to seek help from primary care if they think they have symptoms of LARS, including increased frequency of stool or urgency with or without incontinence of stool.

Expert comment

Picture of Charlotte Dawson, a nurse adviser for Bowel Cancer UK. New guidance covers the management of local disease and secondary tumours.Charlotte Dawson is a nurse adviser for Bowel Cancer UK

‘This new NICE guidance does not significantly differ from the last publication, but there are some important alterations based on a review of the latest evidence.

‘It recommends that for some patients with stage three colon or rectal cancer, three months of chemotherapy can be offered as an alternative to the previous standard of six months. This can be a big benefit for patients, as the treatment can cause a lot of side effects.

‘Another difference is that NICE has recommended aspirin for the prevention of colorectal cancer in people with Lynch syndrome. They have developed a patient decision aid that nurses or doctors can use to help patients decide whether or not to take aspirin.

‘The guidance also highlights the importance of recognition and assessment of LARS. Nurses working in this area will know that LARS can have a significant effect on those affected and they will need ongoing support and management.’


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