Authors' objectives:

This Effective Health Care bulletin summarises the research evidence on the management of colorectal cancers.

Authors' recommendations: 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 C 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 costeffective if patients at higher risk of recurrence are followed up more intensively than those at lower risk.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination